Healthcare Provider Details

I. General information

NPI: 1255776191
Provider Name (Legal Business Name): JESSICA CAROLINA CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR ROAD NW
WASHINGTON DC
20007
US

IV. Provider business mailing address

3800 RESERVOIR ROAD NW
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2468
  • Fax: 202-444-2613
Mailing address:
  • Phone: 202-444-2468
  • Fax: 202-444-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101273963
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD047169
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101273963
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD047169
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: