Provider Demographics
NPI:1760583926
Name:CHANG, DANIEL SIU (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SIU
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4108
Mailing Address - Country:US
Mailing Address - Phone:516-921-4035
Mailing Address - Fax:
Practice Address - Street 1:317 MADISON AVE RM 906
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5244
Practice Address - Country:US
Practice Address - Phone:212-818-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist