Provider Demographics
NPI:1255703682
Name:CHANG U. YI DDS
Entity type:Organization
Organization Name:CHANG U. YI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:U
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-222-2992
Mailing Address - Street 1:4210 FAIRFAX CORNER AVE W
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8619
Mailing Address - Country:US
Mailing Address - Phone:703-222-2992
Mailing Address - Fax:703-222-9252
Practice Address - Street 1:4210 FAIRFAX CORNER AVE W
Practice Address - Street 2:SUITE 225
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8619
Practice Address - Country:US
Practice Address - Phone:703-222-2992
Practice Address - Fax:703-222-9252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty