Healthcare Provider Details

I. General information

NPI: 1164044855
Provider Name (Legal Business Name): GINA CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 4TH ST STE 252
SAN FRANCISCO CA
94158-2324
US

IV. Provider business mailing address

1651 4TH ST STE 252
SAN FRANCISCO CA
94158-2324
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2069
  • Fax:
Mailing address:
  • Phone: 415-353-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA200629
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA200629
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT219800
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: