Provider Demographics
NPI:1235454380
Name:CHANG, CHIA-LIN (LAC, MAO)
Entity Type:Individual
Prefix:
First Name:CHIA-LIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC, MAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 LOVELL AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7906
Mailing Address - Country:US
Mailing Address - Phone:626-321-0572
Mailing Address - Fax:626-226-1215
Practice Address - Street 1:3840 E.FOOTHILL BLVD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-321-0572
Practice Address - Fax:626-226-1215
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12834171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist