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General NPI Number Information
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NPI Number | 1215658380
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Entity Type | Organization
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Legal Business Name | CHANGA LLC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 33710 9TH AVE S STE 7
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6734
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Country | US
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Telephone | 253-517-7058
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Fax |
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Provider Business Mailing Address
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Address Line | 33710 9TH AVE S STE 7
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6734
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Country | US
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Telephone | 253-517-7058
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Fax | 253-517-7139
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD ENNISS HANSON JR.
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Credential | PA
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Telephone | 405-640-9005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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