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General NPI Number Information
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NPI Number | 1114594181
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Entity Type | Individual
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Provider Name | KEVIN J CHANG
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 1805 5TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-1761
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Country | US
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Telephone | 516-281-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 48 ROBERT CIR
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City | SYOSSET
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State | NY
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Zip | 11791-3828
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Country | US
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Telephone | 516-281-4005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 063713
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License Number State | NY
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