Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 213131 | MA |
Y | 207RP1001X | Pulmonary Disease | 213131 | MA |
NPI | 1003929696 |
---|---|
Provider Name | Jacqueline C'yen Chang |
First Address | Boston, MA 02118-3010 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 13/04/2011 |