Healthcare Provider Details

I. General information

NPI: 1982996898
Provider Name (Legal Business Name): MING-CHUAN CHANG WHNP-BC,, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR SUTIE 10
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DRIVE SUTIE 10
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-3849
  • Fax: 951-688-8045
Mailing address:
  • Phone: 951-688-3849
  • Fax: 951-688-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: