Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 09305 | TX |
N | 111NN1001X | Nutrition | 09305 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 09305 | TX |
NPI | 1811655996 |
---|---|
Provider Name | Won Ung Chang |
First Address | Irving, TX 75039-3437 |
Second Address | Irving, TX 75039-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |