Healthcare Provider Details

I. General information

NPI: 1891650206
Provider Name (Legal Business Name): EMILY CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LLEWELLYN AVE
CAMPBELL CA
95008-1948
US

IV. Provider business mailing address

429 LLEWELLYN AVE
CAMPBELL CA
95008-1948
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-6988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: