Provider Demographics
NPI:1720316979
Name:MOSELEY, MENGFEN CHANG (NP)
Entity Type:Individual
Prefix:MRS
First Name:MENGFEN
Middle Name:CHANG
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MENGFEN
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1920 MARENGO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1317
Mailing Address - Country:US
Mailing Address - Phone:323-276-6450
Mailing Address - Fax:323-276-6459
Practice Address - Street 1:1920 MARENGO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-276-6450
Practice Address - Fax:323-276-6459
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19519363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology