Provider Demographics
NPI:1992701221
Name:CHANG, JIN Y (MD)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:Y
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 1:229 SUMMIT ST
Mailing Address - Street 2:STE 5
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1645
Mailing Address - Country:US
Mailing Address - Phone:585-343-4042
Mailing Address - Fax:585-343-7843
Practice Address - Street 1:229 SUMMIT ST
Practice Address - Street 2:STE 5
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-343-4042
Practice Address - Fax:585-343-7843
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-09-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NYA135857-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36006Medicare UPIN
065211Medicare ID - Type Unspecified