Individual
JESSICA CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 PELHAM PKWY S, BRONX, NY 10461-1197
(718) 918-3419
Mailing address
239 E 84TH ST APT 7D, NEW YORK, NY 10028-2960
(650) 868-1201
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
062079-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/19/2020
Last updated
01/06/2022
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