Provider Demographics
NPI:1629272786
Name:LU, CHIA CHANG JENNY (DDS)
Entity Type:Individual
Prefix:MS
First Name:CHIA CHANG
Middle Name:JENNY
Last Name:LU
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 1:1580 W EL CAMINO REAL
Mailing Address - Street 2:3
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-625-8337
Mailing Address - Fax:650-625-8339
Practice Address - Street 1:1580 W EL CAMINO REAL
Practice Address - Street 2:3
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-625-8337
Practice Address - Fax:650-625-8339
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist