Provider Demographics
NPI:1114056843
Name:CHANG, KENNETH YK
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:YK
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 INDEPENDENCE DR
Mailing Address - Street 2:#700
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507
Mailing Address - Country:US
Mailing Address - Phone:907-522-1685
Mailing Address - Fax:907-349-9984
Practice Address - Street 1:9500 INDEPENDENCE DR
Practice Address - Street 2:#700
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-522-1685
Practice Address - Fax:907-349-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist