Provider Demographics
NPI:1619018967
Name:CHANG, SZU TSUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SZU
Middle Name:TSUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SIMON
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9804 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2817
Mailing Address - Country:US
Mailing Address - Phone:909-625-9100
Mailing Address - Fax:
Practice Address - Street 1:9804 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2817
Practice Address - Country:US
Practice Address - Phone:909-625-9100
Practice Address - Fax:909-625-9200
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91221-01OtherMEDICAL