Provider Demographics
NPI:1417563487
Name:CHANG, PEI JU CRYSTAL (LAC)
Entity Type:Individual
Prefix:MS
First Name:PEI JU
Middle Name:CRYSTAL
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:PO BOX 6047
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-1047
Mailing Address - Country:US
Mailing Address - Phone:408-666-7607
Mailing Address - Fax:
Practice Address - Street 1:227 GRAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3449
Practice Address - Country:US
Practice Address - Phone:408-666-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty