Healthcare Provider Details

I. General information

NPI: 1124064381
Provider Name (Legal Business Name): YIH-JIA CHANG PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 SOUTH BLOOMFIELD AVENUE
NORWALK CA
90650
US

IV. Provider business mailing address

1600 9TH STREET ROOM 205 MAILSTOP 2-3
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: