Provider Demographics
NPI:1891893152
Name:CHANG, YAOJEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAOJEN
Middle Name:
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 1:9804 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2817
Mailing Address - Country:US
Mailing Address - Phone:909-625-9100
Mailing Address - Fax:
Practice Address - Street 1:1129 SOUTH GLENDORA AVENUE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-919-7707
Practice Address - Fax:626-851-0985
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist