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General NPI Number Information
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NPI Number | 1194925925
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Entity Type | Individual
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Provider Name | CHANG HE PENG LAC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 25930 KAY AVE APT 202
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City | HAYWARD
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State | CA
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Zip | 94545-2658
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Country | US
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Telephone | 510-598-5883
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Fax |
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Provider Business Mailing Address
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Address Line | 25930 KAY AVE APT 202
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City | HAYWARD
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State | CA
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Zip | 94545-2658
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Country | US
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Telephone | 510-598-5883
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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 | 9292
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License Number State | CA
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