Provider Demographics
NPI:1184894305
Name:CHANG, MICHAEL JUNG-CHAN (DMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JUNG-CHAN
Last Name:CHANG
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 1:8272 E MARBLEHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2375
Mailing Address - Country:US
Mailing Address - Phone:714-281-0225
Mailing Address - Fax:714-994-3995
Practice Address - Street 1:7011 ORANGETHORPE AVE
Practice Address - Street 2:#100
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3321
Practice Address - Country:US
Practice Address - Phone:714-994-4482
Practice Address - Fax:714-994-3995
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist