Provider Demographics
NPI:1043872245
Name:FU, CHANGJIANG
Entity Type:Individual
Prefix:
First Name:CHANGJIANG
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 NANTUCKET CIR APT 361
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3820
Mailing Address - Country:US
Mailing Address - Phone:408-398-9896
Mailing Address - Fax:
Practice Address - Street 1:970 W EL CAMINO REAL STE 6
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1180
Practice Address - Country:US
Practice Address - Phone:408-398-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist