Provider Demographics
NPI:1831175942
Name:CHANG, BASIL TZU LI (DO)
Entity type:Individual
Prefix:DR
First Name:BASIL
Middle Name:TZU LI
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4800 WESTLAKE PKWY
Mailing Address - Street 2:UNIT# 2804
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2071
Mailing Address - Country:US
Mailing Address - Phone:610-348-1917
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:STE 3400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-7506
Practice Address - Fax:916-734-7924
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1249207R00000X, 208M00000X
OH34.012490207R00000X
CA12686208M00000X, 207R00000X
IDO-0638208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507010Medicaid
101730Medicare ID - Type Unspecified
NV100507010Medicaid