Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 241778 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | 247501 | MA |
NPI | 1528116001 |
---|---|
Provider Name | Yushan Chang Wilson |
First Address | Framingham, MA 01702-8264 |
Second Address | Framingham, MA 01702-8264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 31/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110089289 | (05) | MA |