Provider Demographics
NPI:1255971636
Name:CHANG, EUNYUNG (LAC, MSTOM)
Entity type:Individual
Prefix:MS
First Name:EUNYUNG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:MS
Other - First Name:EUN YUNG
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18949 46TH RD FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 CISNEY AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3249
Practice Address - Country:US
Practice Address - Phone:516-460-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NY006677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty