Provider Demographics
NPI:1912697335
Name:CHANG, DANNY HYUNJAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:HYUNJAE
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:HYUNJAE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 MOUNT PLEASANT AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3350
Mailing Address - Country:US
Mailing Address - Phone:781-539-3932
Mailing Address - Fax:
Practice Address - Street 1:542 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-3014
Practice Address - Country:US
Practice Address - Phone:617-322-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859956122300000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program