=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285772921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUI JU CHANG L.AC,. PH.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 07/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1580 OAKLAND RD STE C100
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95131-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-682-0929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1580 OAKLAND RD STE C100
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95131-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-682-0929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 10576
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------