Healthcare Provider Details

I. General information

NPI: 1952126187
Provider Name (Legal Business Name): JENNI CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

103 WATERS PARK CIR
SAN MATEO CA
94403-1191
US

V. Phone/Fax

Practice location:
  • Phone: 650-438-2154
  • Fax:
Mailing address:
  • Phone: 650-438-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number823916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: