Provider Demographics
NPI:1124245790
Name:CHANG, AIMIN (MD LAC)
Entity type:Individual
Prefix:
First Name:AIMIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2582 HEPWORTH DR.
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7671
Mailing Address - Country:US
Mailing Address - Phone:530-756-1269
Mailing Address - Fax:
Practice Address - Street 1:2582 HEPWORTH DR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-7671
Practice Address - Country:US
Practice Address - Phone:530-756-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist