1730391889 NPI number — DR. JONATHAN CHUN-HSIANG CHANG M.D.

Table of content: DR. JONATHAN CHUN-HSIANG CHANG M.D. (NPI 1730391889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730391889 NPI number — DR. JONATHAN CHUN-HSIANG CHANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
JONATHAN
Provider Middle Name:
CHUN-HSIANG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730391889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2922
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONUMENT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80132-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-505-9113
Provider Business Mailing Address Fax Number:
888-939-4319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
MONUMENT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80132-9173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-505-9113
Provider Business Practice Location Address Fax Number:
888-939-4319
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  49210 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 50799 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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