Provider Demographics
NPI:1801314240
Name:CHANG, DAVID U (CDPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:U
Last Name:CHANG
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 119TH AVE SE # 268
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3749
Mailing Address - Country:US
Mailing Address - Phone:206-335-3732
Mailing Address - Fax:
Practice Address - Street 1:5116 196TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6148
Practice Address - Country:US
Practice Address - Phone:425-776-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60180055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60160055OtherCHEMICAL DEPENDENCY PROFESSIONAL TRAINEE CERTIFICATION