Provider Demographics
NPI:1134662828
Name:NGAI AND CHANG DENTAL GROUP
Entity Type:Organization
Organization Name:NGAI AND CHANG DENTAL GROUP
Other - Org Name:SUNNYVALE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DUK GEN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-736-3311
Mailing Address - Street 1:516 W. REMINGTON DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-376-3311
Mailing Address - Fax:408-736-2629
Practice Address - Street 1:516 W REMINGTON DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2470
Practice Address - Country:US
Practice Address - Phone:408-376-3311
Practice Address - Fax:408-736-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100295122300000X
CA610141223P0221X
CA612381223P0221X
CA624131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty