Provider Demographics
NPI:1598024739
Name:EDDIE CHANG DDS, INC.
Entity Type:Organization
Organization Name:EDDIE CHANG DDS, INC.
Other - Org Name:JUST 4 KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:951-303-9555
Mailing Address - Street 1:31940 TEMECULA PKWY
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3836
Mailing Address - Country:US
Mailing Address - Phone:951-303-9555
Mailing Address - Fax:951-303-3311
Practice Address - Street 1:31940 TEMECULA PKWY
Practice Address - Street 2:SUITE C-2
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3836
Practice Address - Country:US
Practice Address - Phone:951-303-9555
Practice Address - Fax:951-303-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty