MEDICARE: TIFFANY CHANG PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	30685	CA

General Provider Information

NPI Number	:	1215452925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CHANG PHD

Provider Business Mailing Address
First Line	:	1500 W EL CAMINO AVE # 420
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1945
Country	:	US
Telephone Number	:	707-640-1498
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 W EL CAMINO AVE # 420
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1945
Country	:	US
Telephone Number	:	707-640-1498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	02/11/2022

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Directions to “ TIFFANY CHANG PHD” Practice Location

Language	Start Address	Practice Location

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