Provider Demographics
NPI:1649611799
Name:CHANG, STEVEN KI WAN JUN
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KI WAN JUN
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 ARBOUR POINT WAY APT 822
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5324
Mailing Address - Country:US
Mailing Address - Phone:407-970-7822
Mailing Address - Fax:
Practice Address - Street 1:1507 S HIAWASSEE RD STE 209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5719
Practice Address - Country:US
Practice Address - Phone:407-286-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice