Provider Demographics
NPI:1023136496
Name:ALBERT S. CHANG D.D.S., INC,
Entity type:Organization
Organization Name:ALBERT S. CHANG D.D.S., INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:909-393-7500
Mailing Address - Street 1:2557 CHINO HILLS PKWY
Mailing Address - Street 2:STE. C
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5103
Mailing Address - Country:US
Mailing Address - Phone:909-393-7500
Mailing Address - Fax:909-393-6222
Practice Address - Street 1:2557 CHINO HILLS PKWY
Practice Address - Street 2:STE. C
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5103
Practice Address - Country:US
Practice Address - Phone:909-393-7500
Practice Address - Fax:909-393-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35858261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental