Provider Demographics
NPI:1588613152
Name:EVA CHANG, INC.
Entity Type:Organization
Organization Name:EVA CHANG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:A P
Authorized Official - Phone:727-773-2511
Mailing Address - Street 1:318 FOUNTAINVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4644
Mailing Address - Country:US
Mailing Address - Phone:813-855-1090
Mailing Address - Fax:
Practice Address - Street 1:28960 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 112
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2403
Practice Address - Country:US
Practice Address - Phone:727-773-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1266171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty