Provider Demographics
NPI:1033522636
Name:FANCHIANG, MIN CHANG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MIN
Middle Name:CHANG
Last Name:FANCHIANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:MIN
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4835 TEMPLE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-4237
Mailing Address - Country:US
Mailing Address - Phone:626-374-4766
Mailing Address - Fax:
Practice Address - Street 1:808 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3607
Practice Address - Country:US
Practice Address - Phone:626-374-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist