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General NPI Number Information
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NPI Number | 1417241746
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Entity Type | Organization
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Legal Business Name | WELLINGTON CHANG, M.D., LLC
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 10721 MAIN ST STE 3200
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-951-3930
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Fax | 888-598-1729
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Provider Business Mailing Address
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Address Line | 10721 MAIN ST STE 3200
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-951-3930
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Fax | 888-598-1729
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Authorized Official
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Title or Position | OWNER
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Name | WELLINGTON CHANG
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Credential | MD
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Telephone | 703-951-3930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101248654
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License Number State | VA
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