Healthcare Provider Details

I. General information

NPI: 1952782377
Provider Name (Legal Business Name): JIMMY CHANG PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CRENSHAW BLVD
LOS ANGELES CA
90008-2522
US

IV. Provider business mailing address

3901 CRENSHAW BLVD
LOS ANGELES CA
90008-2522
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-3330
  • Fax: 323-295-3445
Mailing address:
  • Phone: 323-295-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: