Healthcare Provider Details

I. General information

NPI: 1003252214
Provider Name (Legal Business Name): JAMIE O CHANG, L.AC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 WARNER AVE SUITE 100
FOUNTAIN VALLEY CA
92708-3232
US

IV. Provider business mailing address

8840 WARNER AVE SUITE 100
FOUNTAIN VALLEY CA
92708-3232
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-1500
  • Fax: 714-841-1551
Mailing address:
  • Phone: 714-841-1500
  • Fax: 714-841-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12718
License Number StateCA

VIII. Authorized Official

Name: JAMIE OKHEE CHANG
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 714-841-1500