MEDICARE: YOONJIN CHANG APRN, BC

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	363LF0000X	Family Nurse Practitioner	NP 17484	CA

General Provider Information

NPI Number	:	1902093651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOONJIN CHANG APRN, BC

Provider Business Mailing Address
First Line	:	1141 W REDONDO BEACH BLVD STE 104
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3585
Country	:	US
Telephone Number	:	310-538-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 W REDONDO BEACH BLVD STE 104
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3585
Country	:	US
Telephone Number	:	310-538-9400
Fax Number	:

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	12/22/2021

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