Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 52362 | CA |
NPI | 1023317427 |
---|---|
Provider Name | Lani Chang |
First Address | Irvine, CA 92604-4519 |
Second Address | Irvine, CA 92612-2729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 24/03/2011 |