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General NPI Number Information
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NPI Number | 1114171626
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Entity Type | Individual
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Provider Name | SANGSOON CHANG D.O.M
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Gender | Male
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2617 JUAN TABO BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2966
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Country | US
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Telephone | 505-710-7504
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Fax |
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Provider Business Mailing Address
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Address Line | 12406 NEW DAWN RD NE # RDNE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-4304
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Country | US
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Telephone | 505-710-7504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 960
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License Number State | NM
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