Changlong Su

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61012197 Issued in WA

Practice address

12505 NE Bel Red Rd Ste 188
Bellevue, WA 98005-2510

Phone

(425) 687-2707

Fax

(206) 309-9063

NPI assigned

Nov 16, 2022

Last updated

Nov 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellness Spine Clinic Corp

  • Chiropractor
  • Bellevue, WA
  • NPI 1255758942
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1669181855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17631 115TH PL SE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 NE BEL RED RD STE 188",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052510",
            "telephone_number": "425-687-2707",
            "fax_number": "206-309-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "CHANGLONG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-16",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61012197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Amandus Studer, M.D.
• Marzena Stuj, LMP
• Samuel Cameron Sturgeon
• Allen Su, PHARMD
• Beihong Su, L.AC.
• Chen Su, M.S.
• Cindy Su, LMHCA
• Dan Su, FNP-C
• Helen Su
• Jia Su, PHARM. D

• Massage Therapist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.