Healthcare Provider Details

I. General information

NPI: 1033021951
Provider Name (Legal Business Name): GRACE CHANG MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CAMPUS COMMONS DR STE 225
RESTON VA
20191-1533
US

IV. Provider business mailing address

7407 WALTON LN
ANNANDALE VA
22003-2556
US

V. Phone/Fax

Practice location:
  • Phone: 703-431-6892
  • Fax: 571-617-0037
Mailing address:
  • Phone: 202-669-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: