Provider Demographics
NPI:1457337982
Name:CHANG, BRIAN BYUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BYUNG
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 1:1503 DODONA TER
Mailing Address - Street 2:105
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4717
Mailing Address - Country:US
Mailing Address - Phone:855-373-7688
Mailing Address - Fax:703-771-9877
Practice Address - Street 1:1503 DODONA TER STE 105
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4723
Practice Address - Country:US
Practice Address - Phone:855-373-7688
Practice Address - Fax:202-397-2104
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60251223S0112X
MD134401223S0112X
VA04380003131223S0112X
DCDEN10012581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1457337982Medicaid