Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A61663 | CA |
NPI | 1073673273 |
---|---|
Provider Name | Susan S. Chang |
First Address | Ventura, CA 93003-7329 |
Second Address | Camarillo, CA 93010-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A616630 | (05) | CA |
H37189 | (02) |