Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 16640 | AZ |
Y | 208D00000X | General Practice Physician | 16640 | AZ |
NPI | 1013990563 |
---|---|
Provider Name | Dr. Tich-Hao Mach |
First Address | Glendale, AZ 85301-7769 |
Second Address | Glendale, AZ 85301-7769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 15/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267717 | (05) | AZ |
H19215 | (02) |