Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G36222 | CA |
NPI | 1013936566 |
---|---|
Provider Name | Dr. Stanley Chang |
First Address | Fresno, CA 93711-1767 |
Second Address | Fresno, CA 93702-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G362220 | (05) | CA |
A46615 | (02) | CA |