MEDICARE: JO WAININ CHANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LGP12045	MD

General Provider Information

NPI Number	:	1740922293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO WAININ CHANG

Provider Business Mailing Address
First Line	:	1091 BAY DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7810
Country	:	US
Telephone Number	:	202-669-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1091 BAY DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7810
Country	:	US
Telephone Number	:	202-669-7770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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