Provider Demographics
NPI:1427364918
Name:CHANG, JONG (LAC, OMD, PHD)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC, OMD, PHD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, OMD, PHD
Mailing Address - Street 1:966 S WESTERN AVE
Mailing Address - Street 2:SUITE #206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1013
Mailing Address - Country:US
Mailing Address - Phone:323-735-1905
Mailing Address - Fax:323-735-1905
Practice Address - Street 1:966 S WESTERN AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1013
Practice Address - Country:US
Practice Address - Phone:323-735-1905
Practice Address - Fax:323-735-1905
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist