Healthcare Provider Details

I. General information

NPI: 1629675459
Provider Name (Legal Business Name): CHRISTOPHER CHANG ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W DUARTE RD STE A
ARCADIA CA
91007-7337
US

IV. Provider business mailing address

1780 OAK LN
SAN MARINO CA
91108-1021
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-8828
  • Fax:
Mailing address:
  • Phone: 626-319-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: