Provider Demographics
NPI:1386013209
Name:PHILIP CHANG, DDS, INC.
Entity Type:Organization
Organization Name:PHILIP CHANG, DDS, INC.
Other - Org Name:CHANG FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-217-4542
Mailing Address - Street 1:18208 VILLA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4435
Mailing Address - Country:US
Mailing Address - Phone:626-217-4542
Mailing Address - Fax:
Practice Address - Street 1:8038 GARVEY AVE STE B
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2483
Practice Address - Country:US
Practice Address - Phone:626-571-7000
Practice Address - Fax:626-571-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty