Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2005023723 | MO |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 2005023723 | MO |
NPI | 1013975986 |
---|---|
Provider Name | Chia-Wai David Chang |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65201-6633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I15207 | (02) |