Provider Demographics
NPI:1770672719
Name:CHANG, YOONHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOONHO
Middle Name:
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 1:7024 AIRWAY AVE
Mailing Address - Street 2:SUITE # A
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3069
Mailing Address - Country:US
Mailing Address - Phone:760-365-2351
Mailing Address - Fax:760-365-2351
Practice Address - Street 1:7024 AIRWAY AVE
Practice Address - Street 2:SUITE # A
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3069
Practice Address - Country:US
Practice Address - Phone:760-365-2351
Practice Address - Fax:760-365-2352
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48241122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist