Healthcare Provider Details

I. General information

NPI: 1669632451
Provider Name (Legal Business Name): CHRISTINE CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BELMONT AVE
MENDOTA CA
93640-8232
US

IV. Provider business mailing address

352 W 115TH ST APT 2W
NEW YORK NY
10026-2647
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax:
Mailing address:
  • Phone: 415-987-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAM9707805
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA117416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: