Provider Demographics
NPI:1578649604
Name:ZHANG, JIACHANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIACHANG
Middle Name:
Last Name:ZHANG
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 1:135 S HIDDEN PATH
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5149
Mailing Address - Country:US
Mailing Address - Phone:714-999-0499
Mailing Address - Fax:
Practice Address - Street 1:511 ENCINITAS BLVD STE 118
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3781
Practice Address - Country:US
Practice Address - Phone:760-392-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505521223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50552-01OtherHEALTHY FAMILY