Provider Demographics
NPI:1548287543
Name:TSCHANG, TAI-PO (MD)
Entity type:Individual
Prefix:
First Name:TAI-PO
Middle Name:
Last Name:TSCHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3246
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93650-3246
Mailing Address - Country:US
Mailing Address - Phone:559-455-4053
Mailing Address - Fax:770-666-9102
Practice Address - Street 1:1303 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-3130
Practice Address - Fax:559-450-2035
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32867207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G328670Medicaid
CA00G328670Medicare PIN
A89536Medicare UPIN
CA00G328671Medicare PIN
CA220027657Medicare PIN