Provider Demographics
NPI:1154517977
Name:CHANG, LITEH (LAC)
Entity type:Individual
Prefix:MR
First Name:LITEH
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6652 REEFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5744
Mailing Address - Country:US
Mailing Address - Phone:714-723-5354
Mailing Address - Fax:714-901-8707
Practice Address - Street 1:6652 REEFTON AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5744
Practice Address - Country:US
Practice Address - Phone:714-723-5354
Practice Address - Fax:714-901-8707
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8680171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist