Provider Demographics
NPI:1629412887
Name:CHANG, EMILY (LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
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 1:9742 VALE RD NW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5464
Mailing Address - Country:US
Mailing Address - Phone:571-318-7151
Mailing Address - Fax:
Practice Address - Street 1:7006 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE D
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3218
Practice Address - Country:US
Practice Address - Phone:703-642-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000650171100000X
MDU01904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist