Provider Demographics
NPI:1467320333
Name:CHANG, TA LINDA (LAC)
Entity type:Individual
Prefix:
First Name:TA
Middle Name:LINDA
Last Name:CHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1711 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2216
Mailing Address - Country:US
Mailing Address - Phone:651-402-6777
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N STE 432
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5006
Practice Address - Country:US
Practice Address - Phone:651-402-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2089-55171100000X
MN2119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist