Provider Demographics
NPI:1033297585
Name:LIN, CHANG CHYI (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHANG
Middle Name:CHYI
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1562
Mailing Address - Country:US
Mailing Address - Phone:718-983-7559
Mailing Address - Fax:718-984-5926
Practice Address - Street 1:1303 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1562
Practice Address - Country:US
Practice Address - Phone:718-983-7559
Practice Address - Fax:718-984-5926
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY398931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice