Provider Demographics
NPI:1790098333
Name:CHANG KIT, LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:CHANG KIT
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 1:11181 HEALTH PARK BLVD STE 1115
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5742
Mailing Address - Country:US
Mailing Address - Phone:239-597-4440
Mailing Address - Fax:239-597-4441
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 1115
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5742
Practice Address - Country:US
Practice Address - Phone:239-597-4440
Practice Address - Fax:239-597-4441
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45982208800000X
NY004059208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03480811Medicaid
NYJ400076249Medicare PIN