Provider Demographics
NPI:1003252214
Name:JAMIE O CHANG, L.AC.
Entity Type:Organization
Organization Name:JAMIE O CHANG, L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:OKHEE
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-841-1500
Mailing Address - Street 1:8840 WARNER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3232
Mailing Address - Country:US
Mailing Address - Phone:714-841-1500
Mailing Address - Fax:714-841-1551
Practice Address - Street 1:8840 WARNER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3232
Practice Address - Country:US
Practice Address - Phone:714-841-1500
Practice Address - Fax:714-841-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12718171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty