Provider Demographics
NPI:1134531353
Name:CHANG, TERESA MEI-LAN (LAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MEI-LAN
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7188 BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4242
Mailing Address - Country:US
Mailing Address - Phone:408-315-5432
Mailing Address - Fax:
Practice Address - Street 1:7188 BRIDGE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-4242
Practice Address - Country:US
Practice Address - Phone:408-315-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 16083OtherCALIFORNIA ACUPUNCTURE BOARD