Provider Demographics
NPI:1154471654
Name:CHANG, KATHERINE HEE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:HEE
Last Name:CHANG
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 STEVENS CREEK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1205
Mailing Address - Country:US
Mailing Address - Phone:408-930-1786
Mailing Address - Fax:408-260-9963
Practice Address - Street 1:3680 STEVENS CREEK BLVD STE F
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1205
Practice Address - Country:US
Practice Address - Phone:408-930-1786
Practice Address - Fax:408-260-9963
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.009878111N00000X
IL198.000551171100000X
CAAC17435171100000X
CADC32832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634304OtherBLUECROSS BLUESHIELD
ILK07880Medicare PIN