Provider Demographics
NPI:1326273343
Name:CHANG, IRENE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:C
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 1:40 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3209
Mailing Address - Country:US
Mailing Address - Phone:626-577-0114
Mailing Address - Fax:626-577-0116
Practice Address - Street 1:40 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3209
Practice Address - Country:US
Practice Address - Phone:626-577-0114
Practice Address - Fax:626-577-0116
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics