Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22220 | MA |
NPI | 1083879829 |
---|---|
Provider Name | Dr. David Joey Chang |
First Address | Boston, MA 02111-1527 |
Second Address | Boston, MA 02111-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 16/06/2016 |