Provider Demographics
NPI:1679330955
Name:CHANG, JIN HYE (DAOM)
Entity type:Individual
Prefix:
First Name:JIN HYE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3582 161ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1607
Mailing Address - Country:US
Mailing Address - Phone:917-513-0060
Mailing Address - Fax:
Practice Address - Street 1:3582 161ST ST FL 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1607
Practice Address - Country:US
Practice Address - Phone:917-513-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist