Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G33580 | CA |
N | 207KA0200X | Allergist | G33580 | CA |
N | 208000000X | Pediatrician | G33580 | CA |
N | 2080P0006X | Developmental - Behavioral Pediatrician | G33580 | CA |
N | 2080P0201X | Pediatric Allergist | G33580 | CA |
NPI | 1861561219 |
---|---|
Provider Name | Terrance T Chang |
First Address | Granite Bay, CA 95746-5936 |
Second Address | Roseville, CA 95661-5920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 03/03/2016 |