Healthcare Provider Details

I. General information

NPI: 1205561909
Provider Name (Legal Business Name): BILLIE CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E SHIELDS AVE STE 102
FRESNO CA
93726-6923
US

IV. Provider business mailing address

3520 E SHIELDS AVE
FRESNO CA
93726-6923
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-1230
  • Fax:
Mailing address:
  • Phone: 559-538-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number719629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: