Provider Demographics
NPI:1558375691
Name:CHANG, RICHARD K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
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 1:937 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4135
Mailing Address - Country:US
Mailing Address - Phone:626-285-0285
Mailing Address - Fax:626-281-3866
Practice Address - Street 1:937 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4135
Practice Address - Country:US
Practice Address - Phone:626-285-0285
Practice Address - Fax:626-281-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice