Provider Demographics
NPI:1255713533
Name:CHANG, GEORGE CHIAO-TUNG
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHIAO-TUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17936 CALLE SILVOSA
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2516
Mailing Address - Country:US
Mailing Address - Phone:626-673-3703
Mailing Address - Fax:
Practice Address - Street 1:3120 S HACIENDA BLVD STE 201A
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6305
Practice Address - Country:US
Practice Address - Phone:626-400-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist