Provider Demographics
NPI:1245403682
Name:CHANG, FANG-YU (LAC)
Entity Type:Individual
Prefix:
First Name:FANG-YU
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 HOTSPRING DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6754
Mailing Address - Country:US
Mailing Address - Phone:714-604-6082
Mailing Address - Fax:
Practice Address - Street 1:15865 GALE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1643
Practice Address - Country:US
Practice Address - Phone:626-336-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist