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General NPI Number Information
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NPI Number | 1417390204
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Entity Type | Organization
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Legal Business Name | LIAN S CHANG MD. LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 17900 GULF BLVD APT 7A
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City | REDINGTON SHORES
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State | FL
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Zip | 33708-1102
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Country | US
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Telephone | 651-408-3978
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Fax | 651-636-7273
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Provider Business Mailing Address
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Address Line | 17900 GULF BLVD APT 7A
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City | REDINGTON SHORES
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State | FL
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Zip | 33708-1102
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Country | US
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Telephone | 651-408-3978
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Fax | 651-636-7273
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Authorized Official
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Title or Position | OWNER
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Name | LIAN CHANG
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Credential | M.D.
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Telephone | 651-628-0368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | ME98853
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License Number State | FL
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