Provider Demographics
NPI:1982837761
Name:VONG, CHANG SAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:SAY
Last Name:VONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 VINTAGE PARK DR. #100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829
Mailing Address - Country:US
Mailing Address - Phone:916-525-3200
Mailing Address - Fax:916-307-5178
Practice Address - Street 1:8940 VINTAGE PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1627
Practice Address - Country:US
Practice Address - Phone:916-525-3200
Practice Address - Fax:916-525-1361
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice