Provider Demographics
NPI:1154446375
Name:OFFICES OF ROGER CHANG & THOMAS WONG
Entity Type:Organization
Organization Name:OFFICES OF ROGER CHANG & THOMAS WONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST PARTNER OF OFFICES
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-796-8888
Mailing Address - Street 1:1131 NEWPARK MALL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560
Mailing Address - Country:US
Mailing Address - Phone:510-796-8888
Mailing Address - Fax:510-796-0397
Practice Address - Street 1:1131 NEWPARK MALL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560
Practice Address - Country:US
Practice Address - Phone:510-796-8888
Practice Address - Fax:510-796-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31732122300000X
CA31222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty