Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A33186 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A33186 | CA |
Y | 207ND0900X | Dermatopathologist | A33186 | CA |
N | 207NS0135X | Procedural Dermatology | A33186 | CA |
NPI | 1235136243 |
---|---|
Provider Name | Dong L Chang |
First Address | Arcadia, CA 91006-3108 |
Second Address | Arcadia, CA 91006-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 03/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A27066 | (02) | CA |