Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 18994 | TX |
NPI | 1033133699 |
---|---|
Provider Name | Dr. Andy Chi Chang |
First Address | Plano, TX 75075-7527 |
Second Address | Plano, TX 75075-7527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179019801 | (05) | TX |