Provider Demographics
NPI:1407373145
Name:CHANG, ANGELA YAELIM (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:YAELIM
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:YAELIM
Other - Middle Name:ANGELA
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:770 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1618
Mailing Address - Country:US
Mailing Address - Phone:678-836-2101
Mailing Address - Fax:770-643-2744
Practice Address - Street 1:770 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:630-962-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty