Provider Demographics
NPI:1740387091
Name:CHANG, STEPHANIE HSIN-YIN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:HSIN-YIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 BLUEJAY ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2359
Mailing Address - Country:US
Mailing Address - Phone:909-593-9616
Mailing Address - Fax:
Practice Address - Street 1:1255 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2340
Practice Address - Country:US
Practice Address - Phone:800-780-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1869BMedicare ID - Type Unspecified