Provider Demographics
NPI:1750574158
Name:HAN, CHANG H (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:H
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRAND COVE WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7220
Mailing Address - Country:US
Mailing Address - Phone:201-282-4052
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN STREET
Practice Address - Street 2:C/O BERGEN ORAL SURGERY GROUP, PA
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-343-8297
Practice Address - Fax:201-343-2535
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501961223S0112X
NJ22DI023097001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery