Provider Demographics
NPI:1073938585
Name:CHANG, LILY JEI-HO (ND, EAMP, LAC)
Entity Type:Individual
Prefix:
First Name:LILY JEI-HO
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:ND, EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 102ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2847
Mailing Address - Country:US
Mailing Address - Phone:425-286-7018
Mailing Address - Fax:844-602-4649
Practice Address - Street 1:12710 102ND AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:425-286-7018
Practice Address - Fax:844-602-4649
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60430439171100000X
WANT60454183175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist