Provider Demographics
NPI:1669681342
Name:CHANG, JONATHAN HUI CHONG (LAC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HUI CHONG
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 1:12632 LINCOLN AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3351
Mailing Address - Country:US
Mailing Address - Phone:253-564-2643
Mailing Address - Fax:
Practice Address - Street 1:2211 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1048
Practice Address - Country:US
Practice Address - Phone:253-691-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist