Healthcare Provider Details

I. General information

NPI: 1235454380
Provider Name (Legal Business Name): CHIA-LIN CHANG L.AC., MAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 E.FOOTHILL BLVD.
PASADENA CA
91107
US

IV. Provider business mailing address

1615 LOVELL AVE
ARCADIA CA
91007-7906
US

V. Phone/Fax

Practice location:
  • Phone: 626-321-0572
  • Fax: 626-226-1215
Mailing address:
  • Phone: 626-321-0572
  • Fax: 626-226-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: