Provider Demographics
NPI:1821183609
Name:CHANG, WEI-YUAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WEI-YUAN
Middle Name:
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 1:127 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1661
Mailing Address - Country:US
Mailing Address - Phone:413-567-6728
Mailing Address - Fax:
Practice Address - Street 1:50 HOLYOKE ST
Practice Address - Street 2:HOLYOKE MALL DENTAL HEALTH CENTER
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2709
Practice Address - Country:US
Practice Address - Phone:413-538-7400
Practice Address - Fax:413-534-0900
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0280615Medicaid