Individual
DR. JACQUELINE A. CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9898 GENESEE AVE # AMP615, LA JOLLA, CA 92037-1205
(858) 824-5404
(858) 964-3129
Mailing address
9898 GENESEE AVE # AMP615, LA JOLLA, CA 92037-1205
(858) 824-5404
(858) 964-3129
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
G80136
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G801360
—
CA
01
—
110180430
RAILROAD MEDICARE
—
01
—
F569
CHAMPUS
—
Enumeration date
09/22/2006
Last updated
07/21/2022
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