Healthcare Provider Details

I. General information

NPI: 1548819469
Provider Name (Legal Business Name): CHYONG YUNN CHANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN CHANG BSN RN

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

242-25 OAK PARK DRIVE
LITTLE NECK NY
11362
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2000
  • Fax:
Mailing address:
  • Phone: 646-285-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number702017-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number702017-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number702017-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number702017-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: