Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 19068 | MA |
NPI | 1053433987 |
---|---|
Provider Name | Dr. Ching-Ju Jenny Chang |
First Address | Natick, MA 01760-4713 |
Second Address | Natick, MA 01760-4713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |