Provider Demographics
NPI:1649303348
Name:CHANG, JYH-HANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JYH-HANN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 KAUTZ ROAD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360
Mailing Address - Country:US
Mailing Address - Phone:570-420-1348
Mailing Address - Fax:
Practice Address - Street 1:75 KAUTZ RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-8931
Practice Address - Country:US
Practice Address - Phone:570-420-1348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH250292000OtherMAGELLAN
PA1568536480OtherGOOD SHEPHERD GROUP NPI
OH2107599Medicaid
PA1568536480OtherGOOD SHEPHERD GROUP NPI
PA109813NB0Medicare PIN