Provider Demographics
NPI:1477705705
Name:CHANG, GUANG DI (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:GUANG DI
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 FLANDERS DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2926
Mailing Address - Country:US
Mailing Address - Phone:626-581-7828
Mailing Address - Fax:626-581-7829
Practice Address - Street 1:6727 FLANDERS DR STE 107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2926
Practice Address - Country:US
Practice Address - Phone:626-581-7828
Practice Address - Fax:626-581-7829
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist