Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 54537 | CA |
NPI | 1114191251 |
---|---|
Provider Name | Dr. Glenn Hsuan Chen Chang |
First Address | Diamond Bar, CA 91765-3784 |
Second Address | Diamond Bar, CA 91765-3784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2008 |
Last Update Date | 05/10/2018 |