Provider Demographics
NPI:1528258704
Name:CHANG, JAE KYUNG (DC)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:KYUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8863 W LANE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3975
Mailing Address - Country:US
Mailing Address - Phone:425-985-8993
Mailing Address - Fax:
Practice Address - Street 1:1240 116TH AVE NE
Practice Address - Street 2:101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3815
Practice Address - Country:US
Practice Address - Phone:808-393-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor