MEDICARE: DR. JENSS 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	103TC1900X	Counseling Psychologist
2	103TC0700X	Clinical Psychologist	PSY25491	CA

General Provider Information

NPI Number	:	1942494786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENSS CHANG PHD

Provider Business Mailing Address
First Line	:	8300 UTICA AVE STE 245
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3852
Country	:	US
Telephone Number	:	909-989-4055
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 UTICA AVE STE 245
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3852
Country	:	US
Telephone Number	:	909-989-4055
Fax Number	:

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	07/13/2023

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Directions to “ DR. JENSS CHANG PHD” Practice Location

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