Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC006237 | PA |
N | 222Z00000X | Podiatrist | SC006237 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC006237 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC006237 | PA |
N | 213ES0131X | Foot Surgery | SC006237 | PA |
NPI | 1013228832 |
---|---|
Provider Name | Ms. Jennifer Chang - Ching Van |
First Address | Philadelphia, PA 19107-2418 |
Second Address | Philadelphia, PA 19107-2418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102932319002 | (05) | PA |