Healthcare Provider Details

I. General information

NPI: 1972931715
Provider Name (Legal Business Name): DAVID S CHANG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MCNEESE ST SUITE B
LAKE CHARLES LA
70607-4770
US

IV. Provider business mailing address

524 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5725
US

V. Phone/Fax

Practice location:
  • Phone: 337-491-7569
  • Fax: 337-433-9861
Mailing address:
  • Phone: 337-491-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number206380
License Number StateLA

VIII. Authorized Official

Name: DAVID S CHANG
Title or Position: OWNER
Credential: MD
Phone: 337-491-7569