Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 060315 | NY |
NPI | 1003369695 |
---|---|
Provider Name | Dr. Hyun Chang |
First Address | Oceanside, NY 11572-2229 |
Second Address | Oceanside, NY 11572-2229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2016 |
Last Update Date | 31/07/2019 |