Provider Demographics
NPI:1851521728
Name:CHANG, YAE JIN (LAC)
Entity Type:Individual
Prefix:
First Name:YAE
Middle Name:JIN
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23138 GALVA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3523
Mailing Address - Country:US
Mailing Address - Phone:714-535-3886
Mailing Address - Fax:714-520-0472
Practice Address - Street 1:1126 N BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1702
Practice Address - Country:US
Practice Address - Phone:714-535-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10780171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist