Provider Demographics
NPI:1215658380
Name:CHANGA LLC
Entity type:Organization
Organization Name:CHANGA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:253-517-7058
Mailing Address - Street 1:33710 9TH AVE S STE 7
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6734
Mailing Address - Country:US
Mailing Address - Phone:253-517-7058
Mailing Address - Fax:
Practice Address - Street 1:33710 9TH AVE S STE 7
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6734
Practice Address - Country:US
Practice Address - Phone:253-517-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty