| NPI | 1730527110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CHANG President 855-373-7688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401413779) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401413499) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2013-06-07 |