Provider Demographics
NPI:1598090441
Name:CHANG, JENNIFER T (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
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 1:513 PARNASSUS AVE # 357
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVE # 357
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0538
Practice Address - Country:US
Practice Address - Phone:415-476-2777
Practice Address - Fax:415-476-0659
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111788207R00000X
NY260153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine