Healthcare Provider Details

I. General information

NPI: 1831494772
Provider Name (Legal Business Name): MOON-YUN CHANG L.AC, L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 SE TOLMAN ST
PORTLAND OR
97206-6734
US

IV. Provider business mailing address

5771 SE TOLMAN ST
PORTLAND OR
97206-6734
US

V. Phone/Fax

Practice location:
  • Phone: 206-930-1168
  • Fax:
Mailing address:
  • Phone: 206-930-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC202884
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: