Provider Demographics
NPI:1619218898
Name:CHANG, GUNG-LI (LAC)
Entity Type:Individual
Prefix:DR
First Name:GUNG-LI
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4404
Mailing Address - Country:US
Mailing Address - Phone:615-497-3882
Mailing Address - Fax:
Practice Address - Street 1:1161 MURFREESBORO PIKE
Practice Address - Street 2:#515
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2222
Practice Address - Country:US
Practice Address - Phone:615-497-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNACU0000000211OtherACUPUNCTURE CETIFICATION NO.