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1619935632 NPI number — EDGAR JASON CHANG D.C.

NPI Number: 1619935632
Health Care Provider/Practitioner: EDGAR JASON CHANG D.C.

Information about “1619935632” NPI (EDGAR JASON CHANG D.C.) exists in 1619935632 in HTML format HTML  |  1619935632 in plain Text format TXT  |  1619935632 in PDF (Portable Document Format) PDF  |  1619935632 in an XML format XML  formats.

NPI Number : 1619935632 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619935632",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHANG",
    "FirstName": "EDGAR",
    "MiddleName": "JASON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "190 E STACY RD STE 306-382",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALLEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75002-8734",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-381-0024",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6888 LINCOLN AVE STE J2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BUENA PARK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90620-4107",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-828-2865",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/01/2006",
    "LastUpdateDate": "04/24/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "DC943",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "142065",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "DC28462",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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