Provider Demographics
NPI:1558636654
Name:CHANG, YING (LACU)
Entity Type:Individual
Prefix:
First Name:YING
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CARLETON AVE
Mailing Address - Street 2:3
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2236
Mailing Address - Country:US
Mailing Address - Phone:631-581-9595
Mailing Address - Fax:631-581-9596
Practice Address - Street 1:111 CARLETON AVE
Practice Address - Street 2:3
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2236
Practice Address - Country:US
Practice Address - Phone:631-581-9595
Practice Address - Fax:631-581-9596
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist