Provider Demographics
NPI:1376126912
Name:CHANG, JULIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-8140
Mailing Address - Fax:510-506-7721
Practice Address - Street 1:1651 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2324
Practice Address - Country:US
Practice Address - Phone:415-353-2273
Practice Address - Fax:415-353-2898
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95021697363L00000X
CA95021697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily