Provider Demographics
NPI:1124284708
Name:CHANG, JASON VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:VICTOR
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD ROAD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5113
Mailing Address - Country:US
Mailing Address - Phone:847-240-2211
Mailing Address - Fax:847-240-2418
Practice Address - Street 1:1701 E WOODFIELD ROAD
Practice Address - Street 2:SUITE 1000
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5113
Practice Address - Country:US
Practice Address - Phone:847-240-2211
Practice Address - Fax:847-240-2418
Is Sole Proprietor?:No
Enumeration Date:2008-08-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-0547342084P0800X
IL036-1273212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633897OtherBCBS GROUP NUMBER