Provider Demographics
NPI:1801854153
Name:CHANG, KUANG MIN (DMD)
Entity Type:Individual
Prefix:
First Name:KUANG
Middle Name:MIN
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4404
Mailing Address - Country:US
Mailing Address - Phone:201-946-1000
Mailing Address - Fax:201-946-1641
Practice Address - Street 1:846 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4404
Practice Address - Country:US
Practice Address - Phone:201-946-1000
Practice Address - Fax:201-946-1641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics