Provider Demographics
NPI:1215332333
Name:CHANG, CHI CHENG
Entity type:Individual
Prefix:
First Name:CHI CHENG
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:PO BOX 2732
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-2732
Mailing Address - Country:US
Mailing Address - Phone:408-279-3869
Mailing Address - Fax:
Practice Address - Street 1:1361 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4328
Practice Address - Country:US
Practice Address - Phone:408-279-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15615171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist