Provider Demographics
NPI:1053964015
Name:CHANG, STEPHEN HYUNJIN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HYUNJIN
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 1:19 PEARTREE LN
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4824
Mailing Address - Country:US
Mailing Address - Phone:213-820-7492
Mailing Address - Fax:
Practice Address - Street 1:19 PEARTREE LN
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4824
Practice Address - Country:US
Practice Address - Phone:213-820-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist