Provider Demographics
NPI:1811106438
Name:LIN, JUNG-CHANG (DDS)
Entity type:Individual
Prefix:DR
First Name:JUNG-CHANG
Middle Name:
Last Name:LIN
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 1:19267 COLIMA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3071
Mailing Address - Country:US
Mailing Address - Phone:626-854-3288
Mailing Address - Fax:626-854-3287
Practice Address - Street 1:19267 COLIMA RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3071
Practice Address - Country:US
Practice Address - Phone:626-854-3288
Practice Address - Fax:626-854-3287
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32792-01OtherMEDI-CAL DENTAL PROGRAM