Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | EL6769 | CA |
N | 222Z00000X | Podiatrist | EL6769 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | EL6769 | CA |
N | 213ES0131X | Foot Surgery | EL6769 | CA |
NPI | 1043662158 |
---|---|
Provider Name | Kristina Eunjeong Chang |
First Address | Long Beach, CA 90803-1862 |
Second Address | Lakewood, CA 90805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 13/07/2016 |