Provider Demographics
NPI:1659666527
Name:CHANG, JOSEPHINE ROH-YIH (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ROH-YIH
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 1:18610 BURNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3500
Mailing Address - Country:US
Mailing Address - Phone:708-895-0778
Mailing Address - Fax:
Practice Address - Street 1:18610 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3500
Practice Address - Country:US
Practice Address - Phone:708-895-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018001804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist