Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 56057 | CA |
NPI | 1023334489 |
---|---|
Provider Name | Dr. Lisa Ku Chang |
First Address | Bakersfield, CA 93309-4817 |
Second Address | Bakersfield, CA 93309-4817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2010 |
Last Update Date | 08/01/2014 |