=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669472346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANNY CHUANG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5637 MARINE PKWY
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-585-7020
-----------------------------------------------------
Fax | 727-450-1144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 917839
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32891-7839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-585-7020
-----------------------------------------------------
Fax | 727-450-1144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | OS009615
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------