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SHADY CANYON MEDICAL GROUP
NPI 1922245349
Family Medicine in Irvine, CA

Active since January 08, 2009
15825 LAGUNA CANYON RD STE 104, IRVINE, CA 92618(949) 585-9870(949) 585-9331 Get Directions Write a Review

NPPES record last updated: December 18, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Shady Canyon Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY CANYON MEDICAL GROUP (NPI 1922245349) is a healthcare organization registered as a family medicine in Irvine, California and active in the NPI registry since January 2009. The organization lists Albert Beomjin Chang, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1922245349
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSHADY CANYON MEDICAL GROUP
Location Address15825 LAGUNA CANYON RD STE 104Irvine, CA 92618-2126
Mailing Address15825 Laguna Canyon Rd Ste 104Irvine, CA 92618-2126 · (949) 585-9870 · Fax (949) 585-9331
Phone(949) 585-9870
Fax(949) 585-9331
Organization SubpartNo
Authorized OfficialAlbert Beomjin ChangMd/owner · (949) 585-9870
Enumeration DateJanuary 8, 2009
Last NPPES UpdateDecember 18, 2025
NPPES CertifiedDecember 18, 2025
✔ NPI 1922245349 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A77997
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
15825 LAGUNA CANYON RD STE 104, Irvine, CA 92618
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shady Canyon Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20100408000188Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shady Canyon Medical Group, which bills Medicare for the services this clinician delivers.

Clinician (1)

Albert Chang, M.D.
Family Practice
NPI 1790755569
15825 LAGUNA CANYON RD STE 104
Irvine, CA 92618
(949) 585-9870
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Canyon Medical Group's NPI number?

The NPI number for Shady Canyon Medical Group is 1922245349. It was assigned to this organization in the NPPES registry on January 8, 2009.

Where is Shady Canyon Medical Group located?

Shady Canyon Medical Group is located at 15825 Laguna Canyon Rd Ste 104, Irvine, CA 92618. The listed phone number is (949) 585-9870.

What is Shady Canyon Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Shady Canyon Medical Group enrolled in Medicare?

Yes. Shady Canyon Medical Group is registered in the Medicare PECOS enrollment system.

When is Shady Canyon Medical Group's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Shady Canyon Medical Group?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Shady Canyon Medical Group. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Shady Canyon Medical Group was last updated on December 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.