Provider Demographics
NPI:1174827885
Name:CHANG, KARA WONG (DDS)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:WONG
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DARTMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1620
Mailing Address - Country:US
Mailing Address - Phone:832-409-8052
Mailing Address - Fax:
Practice Address - Street 1:3400 CALIFORNIA ST
Practice Address - Street 2:STE 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1863
Practice Address - Country:US
Practice Address - Phone:415-567-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261081223G0001X
IL019.0286001223G0001X
CA630961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice