Healthcare Provider Details

I. General information

NPI: 1396200010
Provider Name (Legal Business Name): ANNY P CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 INDUSTRIAL RD STE B
SAN CARLOS CA
94070-4152
US

IV. Provider business mailing address

1200 SW 27TH ST
RENTON WA
98057-2603
US

V. Phone/Fax

Practice location:
  • Phone: 650-832-6900
  • Fax:
Mailing address:
  • Phone: 800-287-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61160708
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: