Provider Demographics
NPI:1679889620
Name:CHANG, JERRY YUCHEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:YUCHEN
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 S MARENGO AVE APT C
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3266
Mailing Address - Country:US
Mailing Address - Phone:562-881-9697
Mailing Address - Fax:
Practice Address - Street 1:7900 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3304
Practice Address - Country:US
Practice Address - Phone:323-876-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist