Provider Demographics
NPI:1821151853
Name:CHANG, SEUNG H
Entity Type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MMSC
Mailing Address - Street 1:616 FELLSWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4957
Mailing Address - Country:US
Mailing Address - Phone:781-306-9644
Mailing Address - Fax:781-306-9726
Practice Address - Street 1:616 FELLSWAY STE 2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4957
Practice Address - Country:US
Practice Address - Phone:781-306-9644
Practice Address - Fax:781-306-9726
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210631223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics