Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00040278 | WA |
NPI | 1003844804 |
---|---|
Provider Name | Von Chang |
First Address | Tacoma, WA 98405-4234 |
Second Address | Kent, WA 98030-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 09/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H59810 | (02) | WA |