Provider Demographics
NPI:1891038584
Name:CHANG, JONATHAN YOUNGKWON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:YOUNGKWON
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 1:2301 GALLOWS RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1149
Mailing Address - Country:US
Mailing Address - Phone:703-560-6500
Mailing Address - Fax:703-560-6502
Practice Address - Street 1:2301 GALLOWS RD
Practice Address - Street 2:SUITE 215
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1149
Practice Address - Country:US
Practice Address - Phone:703-560-6500
Practice Address - Fax:703-560-6502
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice