Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A130242 | CA |
N | 2080P0205X | Pediatric Endocrinologist | A130242 | CA |
NPI | 1316294994 |
---|---|
Provider Name | Maria Chang |
First Address | Menlo Park, CA 94026-0226 |
Second Address | San Jose, CA 95128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 29/08/2019 |