Provider Demographics
NPI:1679004691
Name:CHANG, JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 PLACENTIA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3304
Mailing Address - Country:US
Mailing Address - Phone:949-375-8244
Mailing Address - Fax:949-398-9812
Practice Address - Street 1:355 PLACENTIA AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3304
Practice Address - Country:US
Practice Address - Phone:949-375-8244
Practice Address - Fax:949-398-9812
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology