Healthcare Provider Details

I. General information

NPI: 1457702961
Provider Name (Legal Business Name): TRINA CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21102 NORTHVIEW DR
WALNUT CA
91789-2022
US

IV. Provider business mailing address

3207 S BREA CANYON RD STE B
DIAMOND BAR CA
91765-3458
US

V. Phone/Fax

Practice location:
  • Phone: 909-979-7643
  • Fax:
Mailing address:
  • Phone: 909-979-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: