Provider Demographics
NPI:1679635304
Name:CHANG, OHKYOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:OHKYOUNG
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:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188
Mailing Address - Country:US
Mailing Address - Phone:678-445-5444
Mailing Address - Fax:678-445-5552
Practice Address - Street 1:2230 TOWNE LAKE PARKWAY
Practice Address - Street 2:BLDG 1300, STE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:678-445-5444
Practice Address - Fax:678-445-5552
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051391-1122300000X
GADN0136291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist