Healthcare Provider Details

I. General information

NPI: 1114170040
Provider Name (Legal Business Name): LI HUA CHANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13338 41ST RD #1G
FLUSHING NY
11355-3697
US

IV. Provider business mailing address

4616 159TH ST
FLUSHING NY
11358-3629
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-8886
  • Fax:
Mailing address:
  • Phone: 212-300-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0496821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: