Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401413525 | VA |
NPI | 1063824811 |
---|---|
Provider Name | Dr. Ju-Han Chang |
First Address | Falls Church, VA 22043-3500 |
Second Address | Falls Church, VA 22043-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 27/07/2014 |