Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101031281 | VA |
Y | 208600000X | Surgeon | 0101031281 | VA |
NPI | 1003865924 |
---|---|
Provider Name | Yorckay Chang Ishizawar |
First Address | Chester, VA 23836-2600 |
Second Address | Colonial Heights, VA 23834-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7382111 | (05) | VA |
B09205 | (02) | VA |