Provider Demographics
NPI:1104488394
Name:CHANG, LEO YUWEI (DDS)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:YUWEI
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 1:1075 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4701
Mailing Address - Country:US
Mailing Address - Phone:210-685-4369
Mailing Address - Fax:
Practice Address - Street 1:20410 TOWN CENTER LN STE 190
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3230
Practice Address - Country:US
Practice Address - Phone:415-534-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice