Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A91040 | CA |
NPI | 1013958560 |
---|---|
Provider Name | Justin Chang |
First Address | El Monte, CA 91731-1623 |
Second Address | Lancaster, CA 93534-6219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 30/11/2021 |