Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | G78374 | CA |
NPI | 1144328360 |
---|---|
Provider Name | Anthony Chang |
First Address | Orange, CA 92868-3835 |
Second Address | Orange, CA 92868-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G783740 | (05) | CA |
109914 | (02) | CA |