Basic Information
| Provider Information | |||||||||
| NPI: | 1003249244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | SHUINN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22210 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946232210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354000 | ||||||||
| FaxNumber: | 5105354225 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OAKLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945613302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257768200 | ||||||||
| FaxNumber: | 5105354225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 843213 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 23680 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.