Provider Demographics
NPI:1841398054
Name:HENRY S CHANG DDS INC
Entity Type:Organization
Organization Name:HENRY S CHANG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-238-7646
Mailing Address - Street 1:3151 S WHITE RD
Mailing Address - Street 2:#203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4045
Mailing Address - Country:US
Mailing Address - Phone:408-238-7646
Mailing Address - Fax:408-238-8096
Practice Address - Street 1:3151 S WHITE RD
Practice Address - Street 2:#203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-238-7646
Practice Address - Fax:408-238-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty