Healthcare Provider Details

I. General information

NPI: 1992701221
Provider Name (Legal Business Name): JIN Y CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

229 SUMMIT ST STE 5
BATAVIA NY
14020-1645
US

IV. Provider business mailing address

229 SUMMIT ST STE 5
BATAVIA NY
14020-1645
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-4042
  • Fax: 585-343-7843
Mailing address:
  • Phone: 585-343-4042
  • Fax: 585-343-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA135857-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: