Healthcare Provider Details

I. General information

NPI: 1811138027
Provider Name (Legal Business Name): CHANG WHOLISTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W 5TH STREET
OXNARD CA
93030-7059
US

IV. Provider business mailing address

445 W 5TH ST
OXNARD CA
93030-7059
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-3494
  • Fax: 805-487-1605
Mailing address:
  • Phone: 805-486-3494
  • Fax: 805-487-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9892
License Number StateCA

VIII. Authorized Official

Name: LILY CHANG
Title or Position: PRESIDENT
Credential:
Phone: 805-486-3494