Provider Demographics
NPI:1265644546
Name:CHANG, JOHN (DAC, LAC, CA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DAC, LAC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2115
Mailing Address - Country:US
Mailing Address - Phone:908-526-2398
Mailing Address - Fax:
Practice Address - Street 1:183 W HIGH ST
Practice Address - Street 2:FLOOR #2
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1817
Practice Address - Country:US
Practice Address - Phone:908-392-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00030100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist