Provider Demographics
NPI:1184842155
Name:CHANG, SEOK-WON (SEAN) (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEOK-WON (SEAN)
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 MARTIN WAY E STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5325
Mailing Address - Country:US
Mailing Address - Phone:360-455-9544
Mailing Address - Fax:
Practice Address - Street 1:4210 MARTIN WAY E STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5325
Practice Address - Country:US
Practice Address - Phone:360-455-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE107921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice