Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY 15724 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 15724 | CA |
N | 225C00000X | Rehabilitation Counselor | 00004789 |
NPI | 1063583805 |
---|---|
Provider Name | Dr. Timothy T Chiang |
First Address | Gardena, CA 90249-3018 |
Second Address | Gardena, CA 90249-3018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WCP15724A | PPIN (01) | CA |