Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD23576 | OR |
NPI | 1033106034 |
---|---|
Provider Name | Chun-Yang Michael Chang |
First Address | Portland, OR 97232-2684 |
Second Address | Oregon City, OR 97045-1582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033106034 | (05) | WA |
286972 | (05) | OR |
H56117 | (02) |