Provider Demographics
NPI:1861005662
Name:CHANG, KEVIN CHUN HUI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHUN HUI
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 1:160 MORGAN ST APT 509
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6243
Mailing Address - Country:US
Mailing Address - Phone:617-710-4387
Mailing Address - Fax:
Practice Address - Street 1:1508 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2064
Practice Address - Country:US
Practice Address - Phone:505-753-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD5314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist