Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A98479 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | A98479 | CA |
NPI | 1821242199 |
---|---|
Provider Name | Johanna Chi Chang |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-2758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2008 |
Last Update Date | 17/11/2011 |