Provider Demographics
NPI:1952844342
Name:CHANG, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
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 1:1900 RIO CANYON CT
Mailing Address - Street 2:206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6640
Mailing Address - Country:US
Mailing Address - Phone:808-384-3115
Mailing Address - Fax:
Practice Address - Street 1:244 SERENITY RIDGE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5913
Practice Address - Country:US
Practice Address - Phone:702-883-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist