Provider Demographics
NPI:1245573567
Name:CHANG, TERRY (LAC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 W. TEMPLE AVE.
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766
Mailing Address - Country:US
Mailing Address - Phone:909-333-6168
Mailing Address - Fax:
Practice Address - Street 1:3060 W. TEMPLE AVE.
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-333-6168
Practice Address - Fax:909-918-5666
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist