Basic Information
| Provider Information | |||||||||
| NPI: | 1255513859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | LUKE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 NW EXPRESSWAY | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731127230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056074520 | ||||||||
| FaxNumber: | 4056074525 | ||||||||
| Practice Location | |||||||||
| Address1: | 5901 W MEMORIAL RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731422015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057736700 | ||||||||
| FaxNumber: | 4057203910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 01/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 01064419A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 29428 | OK | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 85308 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200479910A | 05 | OK | MEDICAID |