=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487501433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANG XU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 S JERSEY AVE UNIT 7
-----------------------------------------------------
City | SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-974-0531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 BLUETOP RD
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 007894
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------