Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A65091 | CA |
NPI | 1003851809 |
---|---|
Provider Name | Dr. Alice Chiang |
First Address | Santa Rosa, CA 95401-4330 |
Second Address | Santa Rosa, CA 95401-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 23/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A650910 | (05) | CA |
G92331 | (02) | CA |