Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MA38097 | NJ |
NPI | 1053489997 |
---|---|
Provider Name | Dr. Kenneth S. Chang |
First Address | Jersey City, NJ 07306 |
Second Address | Jersey City, NJ 07306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56461 | (02) | NJ |