Provider Demographics
NPI:1083856967
Name:CHANG, JOLIE (MD)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 SUTTER ST
Mailing Address - Street 2:BOX 0342
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3006
Mailing Address - Country:US
Mailing Address - Phone:415-353-2757
Mailing Address - Fax:415-885-7546
Practice Address - Street 1:2380 SUTTER ST FL 1
Practice Address - Street 2:BOX 0342
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3006
Practice Address - Country:US
Practice Address - Phone:415-353-2757
Practice Address - Fax:415-885-7546
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106597207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology