Healthcare Provider Details

I. General information

NPI: 1295641546
Provider Name (Legal Business Name): KYEONG CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 E 86TH ST FL 5
NEW YORK NY
10028-2113
US

IV. Provider business mailing address

157 E 86TH ST FL 5
NEW YORK NY
10028-2113
US

V. Phone/Fax

Practice location:
  • Phone: 718-790-4511
  • Fax:
Mailing address:
  • Phone: 718-790-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: