Healthcare Provider Details

I. General information

NPI: 1598036782
Provider Name (Legal Business Name): SHANYIN AMY CHANG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 SAN PABLO AVE
BERKELEY CA
94702-2204
US

IV. Provider business mailing address

2818 SAN PABLO AVE
BERKELEY CA
94702-2204
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-0694
  • Fax: 408-867-5662
Mailing address:
  • Phone:
  • Fax: 408-867-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: