Healthcare Provider Details

I. General information

NPI: 1114844685
Provider Name (Legal Business Name): STEPHANIE SHARON CHANG MS, RD, CSPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4501
  • Fax:
Mailing address:
  • Phone: 714-509-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1401X
TaxonomyPediatric Critical Care Nutrition Registered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: