Provider Demographics
NPI:1255612347
Name:CHANG, SHI-YING (NP)
Entity type:Individual
Prefix:
First Name:SHI-YING
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:
Practice Address - Street 1:401 E HIGHLAND AVE STE 450A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3803
Practice Address - Country:US
Practice Address - Phone:909-864-4700
Practice Address - Fax:909-883-0459
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20545363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics