Provider Demographics
NPI:1891815197
Name:CHANG, HOON YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOON
Middle Name:YOUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:YOUNG
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:164 W HOSPITALITY LN STE 14
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3329
Mailing Address - Country:US
Mailing Address - Phone:909-888-7817
Mailing Address - Fax:
Practice Address - Street 1:164 W HOSPITALITY LN STE 14
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3329
Practice Address - Country:US
Practice Address - Phone:909-888-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice