Provider Demographics
NPI:1093161432
Name:YJSCHANG ENTERPRISES, PC
Entity Type:Organization
Organization Name:YJSCHANG ENTERPRISES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YURIC
Authorized Official - Middle Name:JUI-SHIH
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-537-3570
Mailing Address - Street 1:105 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-3570
Mailing Address - Fax:978-448-1188
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5507
Practice Address - Country:US
Practice Address - Phone:978-537-3570
Practice Address - Fax:978-448-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty