Provider Demographics
NPI:1811939952
Name:CHANG, DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1441
Mailing Address - Country:US
Mailing Address - Phone:626-833-0770
Mailing Address - Fax:626-294-2996
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-254-9540
Practice Address - Fax:626-294-2996
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI11983Medicare UPIN