Provider Demographics
NPI:1174367718
Name:CHANG, CHINHAO (DC)
Entity type:Individual
Prefix:
First Name:CHINHAO
Middle Name:
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 1:5648 BERGAMO CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3903
Mailing Address - Country:US
Mailing Address - Phone:408-888-3959
Mailing Address - Fax:
Practice Address - Street 1:14800 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2817
Practice Address - Country:US
Practice Address - Phone:408-753-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor