Provider Demographics
NPI:1568627677
Name:VANTAGE RADIATION ONCOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:VANTAGE RADIATION ONCOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-335-4011
Mailing Address - Street 1:1500 ROSECRANS AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3763
Mailing Address - Country:US
Mailing Address - Phone:310-335-4011
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:698 DULUTH HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7645
Practice Address - Country:US
Practice Address - Phone:770-962-8888
Practice Address - Fax:770-963-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty