Healthcare Provider Details

I. General information

NPI: 1205851698
Provider Name (Legal Business Name): HAIYAN CHANG O.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 NW 39TH AVE
GAINESVILLE FL
32605
US

IV. Provider business mailing address

2730 NW 39TH AVE
GAINESVILLE FL
32605-2263
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1320
  • Fax: 352-376-1340
Mailing address:
  • Phone: 352-376-1320
  • Fax: 352-376-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: