Healthcare Provider Details

I. General information

NPI: 1093918807
Provider Name (Legal Business Name): YUFANG JENNIFER CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WASHINGTON ST # 946
SAN DIEGO CA
92103-2110
US

IV. Provider business mailing address

302 WASHINGTON ST # 946
SAN DIEGO CA
92103-2110
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-4407
  • Fax: 619-719-5531
Mailing address:
  • Phone: 619-940-4407
  • Fax: 619-719-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA119710
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberM9206
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM9206
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA119710
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA119710
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM9206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: