Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | B38660 | CA |
NPI | 1093867103 |
---|---|
Provider Name | Chen Der J Chiang |
First Address | Hacienda Heights, CA 91745 |
Second Address | Hacienda Heights, CA 91745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B38660 | DENTICAL (01) | CA |
B3866001 | (05) | CA |