Provider Demographics
NPI:1033531256
Name:JONATHAN C. CHANG, M.D.
Entity Type:Organization
Organization Name:JONATHAN C. CHANG, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-505-9113
Mailing Address - Street 1:PO BOX 2922
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2922
Mailing Address - Country:US
Mailing Address - Phone:719-505-9113
Mailing Address - Fax:888-939-4319
Practice Address - Street 1:212 WASHINGTON ST
Practice Address - Street 2:SUITE F
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9173
Practice Address - Country:US
Practice Address - Phone:719-505-9113
Practice Address - Fax:888-939-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50799251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health