Healthcare Provider Details

I. General information

NPI: 1356256978
Provider Name (Legal Business Name): DIEUDONNE CHANG CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12114 QUADRILLE LN
BOWIE MD
20720-4387
US

IV. Provider business mailing address

12114 QUADRILLE LN
BOWIE MD
20720-4387
US

V. Phone/Fax

Practice location:
  • Phone: 240-707-2743
  • Fax:
Mailing address:
  • Phone: 240-707-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006814
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: