Healthcare Provider Details

I. General information

NPI: 1396142386
Provider Name (Legal Business Name): DIANA JUHEE CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 TELEPHONE RD STE 200
VENTURA CA
93003-5569
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-8252
  • Fax: 805-642-8237
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA154454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: