Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN1855615 | MA |
NPI | 1003114018 |
---|---|
Provider Name | Dr. Jin-Nyung Chang |
First Address | Natick, MA 01760-1566 |
Second Address | Worcester, MA 01605-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 01/03/2011 |