Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 60298 | CA |
NPI | 1083992994 |
---|---|
Provider Name | Dr. Andrew Chang |
First Address | Agoura Hills, CA 91301-4643 |
Second Address | Mission Viejo, CA 92691-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 26/07/2011 |