Provider Demographics
NPI:1750710133
Name:CHANG, ANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S EL MOLINO AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2564
Mailing Address - Country:US
Mailing Address - Phone:626-844-3636
Mailing Address - Fax:626-844-3633
Practice Address - Street 1:175 S EL MOLINO AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2564
Practice Address - Country:US
Practice Address - Phone:626-844-3636
Practice Address - Fax:626-844-3633
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics