Healthcare Provider Details

I. General information

NPI: 1043986730
Provider Name (Legal Business Name): LAN FANG CHANG RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

555 PIERCE ST APT 901
ALBANY CA
94706-1003
US

V. Phone/Fax

Practice location:
  • Phone: 408-876-0287
  • Fax:
Mailing address:
  • Phone: 408-876-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-135917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: