Provider Demographics
NPI:1982996898
Name:CHANG, MING-CHUAN (WHNP-BC,, PHD)
Entity type:Individual
Prefix:
First Name:MING-CHUAN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:WHNP-BC,, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SHERMAN DRIVE
Mailing Address - Street 2:SUTIE 10
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-688-3849
Mailing Address - Fax:951-688-8045
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUTIE 10
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-688-3849
Practice Address - Fax:951-688-8045
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17043363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health