Organization · NPI-2

Beverly Chang MD, INC

Psychiatry & Neurology, Psychiatry · Roseville, CA

NPI number1003272287
StatusActive
Last updated in NPPESAug 3, 2022

Details

NPI
1003272287
Entity type
Organization (NPI-2)
Legal business name
Beverly Chang MD, INC
Organization subpart
No
Enumeration date
Jan 4, 2016
Certification date
Aug 3, 2022
Last updated
Aug 3, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084P0800X Psychiatry & Neurology, PsychiatryA118995CAYes
261QM0850X Clinic/Center, Adult Mental HealthA118995CA

Practice location

1700 Eureka Rd Ste 140a
Roseville, CA 95661-7720

Phone 916-303-4353 · Fax 916-303-4356

Mailing address

1420 E Roseville Pkwy Ste 140-313
Roseville, CA 95661-3078

Authorized official

Beverly Anne Chang
Owner
9163034353

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