Provider Demographics
NPI:1215604574
Name:CHANG, ANDY (ACUPUNCTRUIST)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:ACUPUNCTRUIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2803
Mailing Address - Country:US
Mailing Address - Phone:626-248-0712
Mailing Address - Fax:
Practice Address - Street 1:124 S RAMONA AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-2803
Practice Address - Country:US
Practice Address - Phone:626-248-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist