Provider Demographics
NPI:1619043072
Name:CHANG, FONGHSIEN LU (LAC)
Entity Type:Individual
Prefix:
First Name:FONGHSIEN
Middle Name:LU
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 1:706 TWINBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1427
Mailing Address - Country:US
Mailing Address - Phone:301-251-5838
Mailing Address - Fax:301-251-5838
Practice Address - Street 1:706 TWINBROOK PKWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1427
Practice Address - Country:US
Practice Address - Phone:301-251-5838
Practice Address - Fax:301-251-5838
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist