Provider Demographics
NPI:1417910308
Name:CHANG, LI-FEN LIEN (MD)
Entity Type:Individual
Prefix:
First Name:LI-FEN
Middle Name:LIEN
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 TIMLIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3038
Mailing Address - Country:US
Mailing Address - Phone:740-353-5889
Mailing Address - Fax:
Practice Address - Street 1:1121 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2806
Practice Address - Country:US
Practice Address - Phone:740-356-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2065652085R0001X
OH688672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2602740Medicaid
OHCH4168821Medicare ID - Type Unspecified
OH2602740Medicaid