Basic Information
| Provider Information | |||||||||
| NPI: | 1740573237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | YI SHAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CHANG | ||||||||
| OtherFirstName: | YI SHAN | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 106 E SANTONA CT | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906319261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095693841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18623 GALE AVE | ||||||||
| Address2: | |||||||||
| City: | CITY OF INDUSTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917481342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268390300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 85513 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.