MEDICARE: 123 CLINIC AND ACUPUNCTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171100000X	Acupuncturist	CA
2	207V00000X	Obstetrics & Gynecology Physician	CA
3	207Q00000X	Family Medicine Physician	CA

General Provider Information

NPI Number	:	1770979619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	123 CLINIC AND ACUPUNCTURE

Provider Business Mailing Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE A8
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-593-1233
Fax Number	:	626-608-0318

Provider Business Practice Location Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE A8
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-593-1233
Fax Number	:	626-608-0318

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALLAN C CHANG
Credential	:	LAC, DAOM
Telephone Number	:	626-593-1233

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	03/10/2016

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Directions to “123 CLINIC AND ACUPUNCTURE ” Practice Location

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