Provider Demographics
NPI:1295278844
Name:CHEE CHANG DDSA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CHEE CHANG DDSA PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEE
Authorized Official - Middle Name:CHIANG
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-481-0594
Mailing Address - Street 1:4360 ARDEN WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3153
Mailing Address - Country:US
Mailing Address - Phone:916-481-0594
Mailing Address - Fax:
Practice Address - Street 1:4360 ARDEN WAY STE 5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3153
Practice Address - Country:US
Practice Address - Phone:916-481-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47858261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental