Provider Demographics
NPI:1265976369
Name:WINCHESTER-CHANG, ANDREA DOROTHEA (LAC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DOROTHEA
Last Name:WINCHESTER-CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 ZELZAH AVE
Mailing Address - Street 2:#233
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4675
Mailing Address - Country:US
Mailing Address - Phone:818-451-9715
Mailing Address - Fax:
Practice Address - Street 1:9740 ZELZAH AVE
Practice Address - Street 2:#233
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4675
Practice Address - Country:US
Practice Address - Phone:818-451-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist