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General NPI Number Information
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NPI Number | 1124387287
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Entity Type | Individual
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Provider Name | JAE YONG CHANG L.AC.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 579 BERGEN BLVD FL 2
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2032
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Country | US
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Telephone | 201-945-4372
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Fax |
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Provider Business Mailing Address
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Address Line | 2486 5TH ST
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City | FORT LEE
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State | NJ
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Zip | 07024-7840
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Country | US
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Telephone | 201-945-4372
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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 | 25MZ00030400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001627
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License Number State | NY
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