Provider Demographics
NPI:1225325798
Name:CHANG, SUE YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:YONG
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 1:50 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1865
Mailing Address - Country:US
Mailing Address - Phone:973-377-2361
Mailing Address - Fax:973-377-2667
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1865
Practice Address - Country:US
Practice Address - Phone:973-377-2361
Practice Address - Fax:973-377-2667
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1020323001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice