Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A147705 | CA |
NPI | 1073979332 |
---|---|
Provider Name | Dr. Ki-Eun Chang |
First Address | Los Angeles, CA 90033 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2016 |
Last Update Date | 28/07/2017 |