Provider Demographics
NPI:1952527814
Name:CHANG, JACQUELYN (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-692-2520
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-692-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA615202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry