Provider Demographics
NPI:1629470216
Name:SUSAN S. H. CHANG DDS INC
Entity Type:Organization
Organization Name:SUSAN S. H. CHANG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-715-8080
Mailing Address - Street 1:7380 CLAIREMONT MESA BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1116
Mailing Address - Country:US
Mailing Address - Phone:858-715-8080
Mailing Address - Fax:858-715-8081
Practice Address - Street 1:7380 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1116
Practice Address - Country:US
Practice Address - Phone:858-715-8080
Practice Address - Fax:858-715-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD40213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty