Provider Demographics
NPI:1710270376
Name:CHANG, YONG JUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:JUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W MAIN ST
Mailing Address - Street 2:BOX 122
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1585
Mailing Address - Country:US
Mailing Address - Phone:712-464-3124
Mailing Address - Fax:712-464-7479
Practice Address - Street 1:1331 W MAIN ST
Practice Address - Street 2:BOX 122
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1585
Practice Address - Country:US
Practice Address - Phone:712-464-3124
Practice Address - Fax:712-464-7479
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice