Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G61183 | CA |
NPI | 1003808494 |
---|---|
Provider Name | Dr. Andrew Chang |
First Address | Northridge, CA 91325-4109 |
Second Address | Northridge, CA 91325-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 25/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E37623 | (02) | CA |