Healthcare Provider Details

I. General information

NPI: 1225952278
Provider Name (Legal Business Name): AUTUMN CHANG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W 6TH ST STE 109
CORONA CA
92882-3349
US

IV. Provider business mailing address

6069 E PRADO ST
ANAHEIM CA
92807-3938
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-5828
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: