Provider Demographics
NPI:1639798051
Name:CHANG, RAINA L (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:RAINA
Middle Name:L
Last Name:CHANG
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 W GAGE BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8105
Mailing Address - Country:US
Mailing Address - Phone:509-378-7433
Mailing Address - Fax:
Practice Address - Street 1:8390 W GAGE BLVD STE 113
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8105
Practice Address - Country:US
Practice Address - Phone:509-378-7433
Practice Address - Fax:509-204-3363
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU1289171100000X
WAAC60998031171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist