Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | G80136 | CA |
NPI | 1053410027 |
---|---|
Provider Name | Dr. Jacqueline A. Chang |
First Address | La Jolla, CA 92037-1205 |
Second Address | La Jolla, CA 92037-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 09/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G801360 | (05) | CA |
110180430 | RAILROAD MEDICARE (01) | |
F569 | CHAMPUS (01) | |
G82930 | (02) | CA |