Provider Demographics
NPI:1306019963
Name:DANIEL D. CHANG, DDS,PS
Entity Type:Organization
Organization Name:DANIEL D. CHANG, DDS,PS
Other - Org Name:EAST VALLEY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DOOYONG
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-251-8000
Mailing Address - Street 1:200 SW 41ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4917
Mailing Address - Country:US
Mailing Address - Phone:425-251-8000
Mailing Address - Fax:425-251-6174
Practice Address - Street 1:200 SW 41ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4917
Practice Address - Country:US
Practice Address - Phone:425-251-8000
Practice Address - Fax:425-251-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty