Provider Demographics
NPI:1821415183
Name:CHANG, ALLAN C (LAC, DOM, DAOM)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:C
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC, DOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 AMAR RD STE C12
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4561
Mailing Address - Country:US
Mailing Address - Phone:626-788-9691
Mailing Address - Fax:626-608-0318
Practice Address - Street 1:18800 AMAR RD STE C12
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4561
Practice Address - Country:US
Practice Address - Phone:626-788-9691
Practice Address - Fax:626-608-0318
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA000150146M00000X
CAAC 15822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate