Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | P84589 | NY |
Y | 222Z00000X | Podiatrist | P84589 | NY |
NPI | 1073012720 |
---|---|
Provider Name | Dr. Won Ho Chang |
First Address | New York, NY 10001-3841 |
Second Address | New York, NY 10001-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2018 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C31877880004751 | PODIATRY (01) | NJ |