Provider Demographics
NPI:1073889556
Name:JIANN E CHANG M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JIANN E CHANG M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-256-3508
Mailing Address - Street 1:801 E MOUNTAIN VIEW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3052
Mailing Address - Country:US
Mailing Address - Phone:760-256-3508
Mailing Address - Fax:760-256-3509
Practice Address - Street 1:801 E MOUNTAIN VIEW ST
Practice Address - Street 2:SUITE A
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3052
Practice Address - Country:US
Practice Address - Phone:760-256-3508
Practice Address - Fax:760-256-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A30510305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87402Medicare UPIN