Provider Demographics
NPI:1780842997
Name:CHANG, CHUNG YOUNG (OMD)
Entity Type:Individual
Prefix:
First Name:CHUNG YOUNG
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OMD
Mailing Address - Street 1:452 W. FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-287-7369
Mailing Address - Fax:
Practice Address - Street 1:452 W. FRONT ST.
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-287-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8360C171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist