Provider Demographics
NPI:1447576327
Name:CHANG, DOUG SOON (DDS)
Entity Type:Individual
Prefix:
First Name:DOUG SOON
Middle Name:
Last Name:CHANG
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 1:2234-A SOUTH EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6501
Mailing Address - Country:US
Mailing Address - Phone:909-986-6866
Mailing Address - Fax:909-986-1053
Practice Address - Street 1:2234-A SOUTH EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6501
Practice Address - Country:US
Practice Address - Phone:909-986-6866
Practice Address - Fax:909-986-1053
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist