Provider Demographics
NPI:1316618200
Name:CHANG, MINHEE LEE (LAC)
Entity type:Individual
Prefix:
First Name:MINHEE
Middle Name:LEE
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MINNIE
Other - Middle Name:
Other - Last Name:C
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1437 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4154
Mailing Address - Country:US
Mailing Address - Phone:323-887-7575
Mailing Address - Fax:
Practice Address - Street 1:1437 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4154
Practice Address - Country:US
Practice Address - Phone:323-887-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19264171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist