Provider Demographics
NPI:1336572379
Name:CHANG, XIN
Entity Type:Individual
Prefix:
First Name:XIN
Middle Name:
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 1:3375 SCOTT BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3110
Mailing Address - Country:US
Mailing Address - Phone:408-215-1683
Mailing Address - Fax:
Practice Address - Street 1:3375 SCOTT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3110
Practice Address - Country:US
Practice Address - Phone:408-215-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC#12136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist