Healthcare Provider Details

I. General information

NPI: 1083355085
Provider Name (Legal Business Name): KATIE YEU CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND ST
JERSEY CITY NJ
07302-4321
US

IV. Provider business mailing address

2200 VICTORY PKWY APT 707
CINCINNATI OH
45206-2823
US

V. Phone/Fax

Practice location:
  • Phone: 248-933-8289
  • Fax:
Mailing address:
  • Phone: 248-933-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA13193500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: