Provider Demographics
NPI:1255651238
Name:CHANG, YOUNG JAI (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:JAI
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7006 LITTLE RIVER TPKE
Mailing Address - Street 2:STE D
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3218
Mailing Address - Country:US
Mailing Address - Phone:703-642-5488
Mailing Address - Fax:703-642-5489
Practice Address - Street 1:7006 LITTLE RIVER TPKE
Practice Address - Street 2:STE D
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3218
Practice Address - Country:US
Practice Address - Phone:703-642-5488
Practice Address - Fax:703-642-5489
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0121000553171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist