Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A126071 | CA |
Y | 213ES0000X | Sports Medicine | A126071 | CA |
N | 2081S0010X | Sports Medicine | TMP 02914 | WV |
N | 213ES0000X | Sports Medicine | TMP 02914 | WV |
NPI | 1205128196 |
---|---|
Provider Name | Dr. Enoch H Chang |
First Address | Canonsburg, PA 15317-6800 |
Second Address | Fresno, CA 93720-3391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 24/07/2019 |