Provider Demographics
NPI:1417055856
Name:NGHIEM, CHANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:
Last Name:NGHIEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 65 TH STREET,SUITE#8
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-1264
Mailing Address - Country:US
Mailing Address - Phone:916-399-1888
Mailing Address - Fax:916-399-9413
Practice Address - Street 1:6880 65TH ST
Practice Address - Street 2:STE 8
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-1264
Practice Address - Country:US
Practice Address - Phone:916-399-1888
Practice Address - Fax:916-399-9413
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice