Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A106597 | CA |
NPI | 1083856967 |
---|---|
Provider Name | Jolie Chang |
First Address | San Francisco, CA 94115-3006 |
Second Address | San Francisco, CA 94115-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 05/03/2012 |