Healthcare Provider Details

I. General information

NPI: 1679939201
Provider Name (Legal Business Name): JONI CHANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

617 24TH ST APT 4
SACRAMENTO CA
95816-3678
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5444
  • Fax:
Mailing address:
  • Phone: 301-404-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number22643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: