Provider Demographics
NPI:1790094373
Name:CHANG, CHEN CHI
Entity Type:Individual
Prefix:
First Name:CHEN CHI
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19655 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3303
Mailing Address - Country:US
Mailing Address - Phone:408-433-1688
Mailing Address - Fax:408-252-0621
Practice Address - Street 1:19655 ASHTON CT
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3303
Practice Address - Country:US
Practice Address - Phone:408-433-1688
Practice Address - Fax:408-252-0621
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13796171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist