Provider Demographics
NPI:1588721955
Name:CHANG, PHILLIP JINGO (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JINGO
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 DEERFIELD AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6820
Mailing Address - Country:US
Mailing Address - Phone:703-729-5553
Mailing Address - Fax:703-729-1694
Practice Address - Street 1:19450 DEERFIELD AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6820
Practice Address - Country:US
Practice Address - Phone:703-729-5553
Practice Address - Fax:703-729-1694
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG35083Medicare UPIN