Provider Demographics
NPI:1407995509
Name:CHANG, CHEHSIN (LAC)
Entity Type:Individual
Prefix:
First Name:CHEHSIN
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 1:10 EUGENIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5412
Mailing Address - Country:US
Mailing Address - Phone:415-626-6189
Mailing Address - Fax:415-285-8694
Practice Address - Street 1:10 EUGENIA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5412
Practice Address - Country:US
Practice Address - Phone:415-626-6189
Practice Address - Fax:415-285-8694
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist