Provider Demographics
NPI:1922764083
Name:CHANG, SU YEUN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SU YEUN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18773 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2949
Mailing Address - Country:US
Mailing Address - Phone:626-986-4899
Mailing Address - Fax:
Practice Address - Street 1:18773 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2949
Practice Address - Country:US
Practice Address - Phone:626-986-4899
Practice Address - Fax:626-986-4855
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily