Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A104580 | CA |
NPI | 1043515430 |
---|---|
Provider Name | Thomas Fong-Jen Chang |
First Address | Baltimore, MD 21297-3215 |
Second Address | Washington, DC 20010-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 25/09/2013 |