Healthcare Provider Details

I. General information

NPI: 1306194915
Provider Name (Legal Business Name): TANGEL CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 CONFERENCE DR
TOLEDO OH
43614
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-4541
  • Fax: 419-383-3040
Mailing address:
  • Phone: 419-383-4541
  • Fax: 419-383-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number1306194915
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number34.012242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: