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General NPI Number Information
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NPI Number | 1356557284
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Entity Type | Individual
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Provider Name | LILIA CHANG DE JESUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1001 POTRERO AVENUE BLDG. 5, #6M
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 628-206-8361
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743749
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City | LOS ANGELES
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State | CA
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Zip | 90074-3749
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301078225
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 121019
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A121019
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License Number State | CA
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