Provider Demographics
NPI:1811138027
Name:CHANG WHOLISTIC CLINIC
Entity type:Organization
Organization Name:CHANG WHOLISTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-486-3494
Mailing Address - Street 1:445 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7059
Mailing Address - Country:US
Mailing Address - Phone:805-486-3494
Mailing Address - Fax:805-487-1605
Practice Address - Street 1:445 W 5TH STREET
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7059
Practice Address - Country:US
Practice Address - Phone:805-486-3494
Practice Address - Fax:805-487-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801092622OtherINDIVIDUAL NPI