Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | DO26736 | OR |
N | 2080P0202X | Pediatric Cardiologist | OP00002095 | WA |
NPI | 1003926189 |
---|---|
Provider Name | Dr. Peter H Chang |
First Address | Vancouver, WA 98682-0030 |
Second Address | Portland, OR 97227-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1123090 | MEDICAID (01) | WA |
213128 | (05) | OR |