Healthcare Provider Details

I. General information

NPI: 1578404380
Provider Name (Legal Business Name): JIM CHANG CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIMMY CHANG

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CHENERY ST
SAN FRANCISCO CA
94131-3095
US

IV. Provider business mailing address

605 CHENERY ST
SAN FRANCISCO CA
94131-3095
US

V. Phone/Fax

Practice location:
  • Phone: 949-310-2959
  • Fax:
Mailing address:
  • Phone: 949-310-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: