Healthcare Provider Details

I. General information

NPI: 1881269017
Provider Name (Legal Business Name): JONAH CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 ROSECRANS AVE STE 300
MANHATTAN BEACH CA
90266-2494
US

IV. Provider business mailing address

5530 CORBIN AVE STE 221
TARZANA CA
91356-6095
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-8402
  • Fax:
Mailing address:
  • Phone: 818-600-8758
  • Fax: 833-728-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: