Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0019 | SC |
N | 1223P0106X | Oral and Maxillofacial Pathology | DS030650L | PA |
NPI | 1255304606 |
---|---|
Provider Name | Dr. Angela C Chi |
First Address | Charleston, SC 29425-0001 |
Second Address | Charleston, SC 29425-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00147013 | MEDICARE RAILROAD CARRIER (01) | SC |
V00925 | (02) | |
ZX0019 | (05) | SC |