Provider Demographics
NPI:1245401108
Name:CHANG, KHANH (OD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 POTOMAC STATION DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1817
Mailing Address - Country:US
Mailing Address - Phone:703-669-4646
Mailing Address - Fax:
Practice Address - Street 1:617 POTOMAC STATION DR NE STE A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1817
Practice Address - Country:US
Practice Address - Phone:703-669-4646
Practice Address - Fax:703-669-9322
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1768152W00000X
VA0618001215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist