Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G74401 | CA |
N | 111NI0900X | Internist | G74401 | CA |
N | 207RH0000X | Hematologist | G74401 | CA |
Y | 207RX0202X | Medical Oncology | G74401 | CA |
NPI | 1427123488 |
---|---|
Provider Name | Eric Cheng Kun Chang |
First Address | Monterey Park, CA 91754-1169 |
Second Address | Monterey Park, CA 91754-1169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G61086 | (02) | |
OG7440100 | (05) | CA |