Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 052042 | MI |
NPI | 1215025796 |
---|---|
Provider Name | Dr. Christopher Yon Chang |
First Address | Hazel Park, MI 48030 |
Second Address | Hazel Park, MI 48030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A73389 | (02) | MI |