Provider Demographics
NPI:1598458598
Name:CHANG, HYEON JEONG
Entity Type:Individual
Prefix:MS
First Name:HYEON JEONG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 BURNET AVE.
Mailing Address - Street 2:UNIT 119
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343
Mailing Address - Country:US
Mailing Address - Phone:818-621-3606
Mailing Address - Fax:
Practice Address - Street 1:15350 SHERMAN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-267-1100
Practice Address - Fax:818-267-1199
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program