Provider Demographics
NPI:1770696056
Name:CHANG, CHRISTINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR
Practice Address - Street 2:#265
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4904
Practice Address - Country:US
Practice Address - Phone:925-648-7140
Practice Address - Fax:925-648-0878
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77503OtherCA LICENSE
CAP01090342OtherRAILROAD MEDICARE
CAGE846ZMedicare PIN
CAP01090342OtherRAILROAD MEDICARE