Provider Demographics
NPI:1891002556
Name:CHANG, ASHLEY PATRICE CHU (MSOT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PATRICE CHU
Last Name:CHANG
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:PATRICE
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT
Mailing Address - Street 1:9610 GRANITE RIDGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-505-5420
Mailing Address - Fax:
Practice Address - Street 1:9610 GRANITE RIDGE DR STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2684
Practice Address - Country:US
Practice Address - Phone:858-505-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist