Provider Demographics
NPI:1780868984
Name:CHANG, JEAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:L
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 E CATALINA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730
Mailing Address - Country:US
Mailing Address - Phone:559-434-2902
Mailing Address - Fax:916-327-2476
Practice Address - Street 1:823 E CATALINA CIR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0857
Practice Address - Country:US
Practice Address - Phone:559-434-2902
Practice Address - Fax:916-327-2476
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist