Healthcare Provider Details

I. General information

NPI: 1780844456
Provider Name (Legal Business Name): MR. YING CHUN CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YING CHUN CHANG LAC

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MERIDIAN AVE STE 16
SAN JOSE CA
95126-2905
US

IV. Provider business mailing address

1135 EAGLE CLIFF CT
SAN JOSE CA
95120-5819
US

V. Phone/Fax

Practice location:
  • Phone: 408-821-2779
  • Fax:
Mailing address:
  • Phone: 408-821-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: