Provider Demographics
NPI:1598963290
Name:CHANG, MAN-KUANG (MD)
Entity type:Individual
Prefix:DR
First Name:MAN-KUANG
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAUNG THURA MOE
Other - Middle Name:
Other - Last Name:KYAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:820 PRUDENTIAL DR STE 515
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8207
Practice Address - Country:US
Practice Address - Phone:904-396-4886
Practice Address - Fax:904-390-7487
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103472207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001467800Medicaid
FLP00787542OtherRAILROAD MEDICARE
FLP00787542OtherRAILROAD MEDICARE