Provider Demographics
NPI:1700189313
Name:CHANG, MI YOUNG (LAC)
Entity Type:Individual
Prefix:MS
First Name:MI YOUNG
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 1:4082 WHITTIER BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2558
Mailing Address - Country:US
Mailing Address - Phone:323-980-0876
Mailing Address - Fax:
Practice Address - Street 1:4082 WHITTIER BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2558
Practice Address - Country:US
Practice Address - Phone:323-980-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13842171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist