Provider Demographics
NPI:1619218427
Name:CHANG, DANIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:STE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5164
Mailing Address - Fax:703-890-2650
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-466-8153
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2016-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY592623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400087409Medicare UPIN