Provider Demographics
NPI:1972112514
Name:CHANG, VICTORIA (DMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 41ST AVE SW UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4218
Mailing Address - Country:US
Mailing Address - Phone:321-616-1235
Mailing Address - Fax:
Practice Address - Street 1:4437 41ST AVE SW UNIT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4218
Practice Address - Country:US
Practice Address - Phone:321-616-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61070878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist