Healthcare Provider Details

I. General information

NPI: 1245358985
Provider Name (Legal Business Name): AGNES JU CHANG M.D., F.A.A.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K ST NW STE 307
WASHINGTON DC
20037-1810
US

IV. Provider business mailing address

2141 K ST NW STE 307
WASHINGTON DC
20037-1810
US

V. Phone/Fax

Practice location:
  • Phone: 202-293-3990
  • Fax: 202-496-9103
Mailing address:
  • Phone: 202-293-3990
  • Fax: 202-496-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD037509
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: