Provider Demographics
NPI:1831494772
Name:CHANG, MOON-YUN (LAC, LMP)
Entity Type:Individual
Prefix:MS
First Name:MOON-YUN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 40TH AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116
Mailing Address - Country:US
Mailing Address - Phone:206-930-1168
Mailing Address - Fax:
Practice Address - Street 1:4141 40TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4211
Practice Address - Country:US
Practice Address - Phone:206-930-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60187037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist