Provider Demographics
NPI:1477796522
Name:CHANG, STEVEN SUN
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SUN
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:SUN
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14735 RICK LN.
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880
Mailing Address - Country:US
Mailing Address - Phone:951-310-5637
Mailing Address - Fax:
Practice Address - Street 1:14735 RICK LN
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-3546
Practice Address - Country:US
Practice Address - Phone:951-310-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist