Provider Demographics
NPI:1982668422
Name:CHANG, JENNIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:J
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 255 SOUTH LOBBY
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-304-2626
Mailing Address - Fax:626-585-0695
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-304-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology