Provider Demographics
NPI:1649229048
Name:CHANG, MEI-I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEI-I
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 MENLO AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4436
Mailing Address - Country:US
Mailing Address - Phone:619-563-5339
Mailing Address - Fax:
Practice Address - Street 1:3821 FRONT STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-200-5483
Practice Address - Fax:619-294-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical