Provider Demographics
NPI:1386859163
Name:CHANG, YOON JEONG (MD)
Entity Type:Individual
Prefix:
First Name:YOON JEONG
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 1:3280 NORTHSIDE PKWY NW
Mailing Address - Street 2:APT 202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2253
Mailing Address - Country:US
Mailing Address - Phone:248-229-1920
Mailing Address - Fax:
Practice Address - Street 1:1791 MULKEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1124
Practice Address - Country:US
Practice Address - Phone:770-732-5400
Practice Address - Fax:770-994-0327
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59615207V00000X
MI4301082153207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics