Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NPF21408 | CA |
NPI | 1003173410 |
---|---|
Provider Name | Shirley Wan Yu Chiang |
First Address | San Gabriel, CA 91776-3731 |
Second Address | San Gabriel, CA 91776-3731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 20/09/2012 |