Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 162345 | NY |
NPI | 1295994200 |
---|---|
Provider Name | Dr. June Irene Chang |
First Address | Holland, NY 14080-9621 |
Second Address | Buffalo, NY 14215-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 04/06/2008 |