Provider Demographics
NPI:1598036782
Name:CHANG, SHANYIN AMY (LAC)
Entity Type:Individual
Prefix:
First Name:SHANYIN
Middle Name:AMY
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19527 VIA MONTE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:408-867-5662
Practice Address - Street 1:642 63RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1218
Practice Address - Country:US
Practice Address - Phone:510-684-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14359171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist