Provider Demographics
NPI:1902093651
Name:CHANG, YOONJIN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:YOONJIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3585
Mailing Address - Country:US
Mailing Address - Phone:310-538-9400
Mailing Address - Fax:
Practice Address - Street 1:1141 W REDONDO BEACH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3585
Practice Address - Country:US
Practice Address - Phone:310-538-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily