Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 02004731A | IN |
N | 111NI0900X | Internist | 02004731A | IN |
Y | 207RG0300X | Geriatric Medicine | 02004731A | IN |
N | 207RG0300X | Geriatric Medicine | 253044 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 02004731A | IN |
NPI | 1063526291 |
---|---|
Provider Name | Joan Chyong-Wen Chang |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-1954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 02/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03111199 | (05) | NY |
0415706 | INDEPENDENT HEALTH (01) | NY |