Healthcare Provider Details

I. General information

NPI: 1861521270
Provider Name (Legal Business Name): JUDY AN-PING CHANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 PONCE AVE
BELMONT CA
94002-1541
US

IV. Provider business mailing address

2606 PONCE AVE
BELMONT CA
94002-1541
US

V. Phone/Fax

Practice location:
  • Phone: 650-533-8678
  • Fax:
Mailing address:
  • Phone: 650-533-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number698844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: