Provider Demographics
NPI:1558978957
Name:CHANG, TIEN-HSIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIEN-HSIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
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:ONE KNEELAND STREET, 12 FLOOR, PERIODONTOLOGY CLINIC
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-459-0481
Mailing Address - Fax:
Practice Address - Street 1:240 S 40TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6030
Practice Address - Country:US
Practice Address - Phone:215-898-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2023-10-26
Deactivation Date:2021-10-20
Deactivation Code:
Reactivation Date:2022-04-29
Provider Licenses
StateLicense IDTaxonomies
PARFD0000661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics