Provider Demographics
NPI:1578027298
Name:CHANG, C MAY
Entity Type:Individual
Prefix:
First Name:C MAY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 TASMANIAN TIGER TRCE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-4763
Mailing Address - Country:US
Mailing Address - Phone:512-917-5484
Mailing Address - Fax:
Practice Address - Street 1:1804 TASMANIAN TIGER TRCE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-4763
Practice Address - Country:US
Practice Address - Phone:512-917-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01586171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist