Provider Demographics
NPI:1215477450
Name:CHANG, SANDY (LAC, LMT)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:CHANG
Suffix:
Gender:
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-468 LIPALU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2210
Mailing Address - Country:US
Mailing Address - Phone:808-391-8884
Mailing Address - Fax:
Practice Address - Street 1:85-979 FARRINGTON HWY STE E
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2678
Practice Address - Country:US
Practice Address - Phone:808-391-8884
Practice Address - Fax:808-278-9299
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 4600225700000X
HIACU 1196171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist