Provider Demographics
NPI:1639329162
Name:CHANG, MEI KWAN (DDS)
Entity Type:Individual
Prefix:
First Name:MEI KWAN
Middle Name:
Last Name:CHANG
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 1:956 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1450
Mailing Address - Country:US
Mailing Address - Phone:716-874-7112
Mailing Address - Fax:716-874-7113
Practice Address - Street 1:956 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1450
Practice Address - Country:US
Practice Address - Phone:716-874-7112
Practice Address - Fax:716-874-7113
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0540731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice