Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 270617 | NY |
NPI | 1013151471 |
---|---|
Provider Name | Dr. Kaliq Trimble Chang |
First Address | West Orange, NJ 07052 |
Second Address | West Orange, NJ 07052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 30/12/2015 |