Provider Demographics
NPI:1962649145
Name:CHANG, DAVID TSAN-RUE (L AC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TSAN-RUE
Last Name:CHANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6733 185TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3511
Mailing Address - Country:US
Mailing Address - Phone:917-658-3296
Mailing Address - Fax:
Practice Address - Street 1:6733 185TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3511
Practice Address - Country:US
Practice Address - Phone:917-658-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003809171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist