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General NPI Number Information
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NPI Number | 1407268618
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Entity Type | Organization
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Legal Business Name | LAWC DERMATOLOGY
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 8221 ROCHESTER AVE STE 130
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0721
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Country | US
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Telephone | 609-497-7662
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Fax |
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Provider Business Mailing Address
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Address Line | 832 MAGNOLIA AVE UNIT 10
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City | PASADENA
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State | CA
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Zip | 91106-4603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. LAURA CHANG
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Credential | M.D
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Telephone | 609-497-7662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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