Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036-109430 | IL |
N | 2080P0201X | Pediatric Allergist | 49223 | WI |
NPI | 1316988850 |
---|---|
Provider Name | Mr. Titus Chang |
First Address | Aurora, IL 60506-6222 |
Second Address | Aurora, IL 60506-6209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036109430 | (05) | IL |