Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1993 | OR |
NPI | 1073941399 |
---|---|
Provider Name | David Chang |
First Address | Portland, OR 97210-3442 |
Second Address | Portland, OR 97210-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |