Provider Demographics
NPI:1275969032
Name:CHANG, INSOON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:INSOON
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 ROSE AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6086
Mailing Address - Country:US
Mailing Address - Phone:310-502-0073
Mailing Address - Fax:
Practice Address - Street 1:11140 ROSE AVE APT 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6086
Practice Address - Country:US
Practice Address - Phone:310-502-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist