Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 23680 | CA |
NPI | 1003249244 |
---|---|
Provider Name | Shuinn Chang |
First Address | Oakland, CA 94623-2210 |
Second Address | Oakley, CA 94561-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 24/09/2013 |