Healthcare Provider Details

I. General information

NPI: 1932496908
Provider Name (Legal Business Name): CONCOURSE DIAGNOSTIC AND SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18575 GALE AVE STE 198
CITY OF INDUSTRY CA
91748-1382
US

IV. Provider business mailing address

18575 E. GALE AVE STE 198
CITY OF INDUSTRY CA
91748-1340
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-3880
  • Fax:
Mailing address:
  • Phone: 626-965-3880
  • Fax: 626-965-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. HENRY H. CHANG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-273-5378