Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A106131 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 22015 | MD |
NPI | 1003015462 |
---|---|
Provider Name | Dr. Chun Joey Chang |
First Address | Livermore, CA 94550-3768 |
Second Address | Modesto, CA 95351-3163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 30/07/2013 |