Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D5057 | AZ |
Y | 122300000X | Dentist | DD1951 | NM |
NPI | 1013014554 |
---|---|
Provider Name | Shu-Ching Catherine Chang |
First Address | Albuquerque, NM 87107 |
Second Address | Albuquerque, NM 87107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 08/07/2007 |