Provider Demographics
NPI:1194921916
Name:MICHAEL J.C. CHANG, DMD, INC.
Entity type:Organization
Organization Name:MICHAEL J.C. CHANG, DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUNG-CHAN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-994-4482
Mailing Address - Street 1:7011 ORANGETHORPE AVE.
Mailing Address - Street 2:#100
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621
Mailing Address - Country:US
Mailing Address - Phone:714-994-4482
Mailing Address - Fax:714-994-3995
Practice Address - Street 1:7011 ORANGETHORPE AVE.
Practice Address - Street 2:#100
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-994-4482
Practice Address - Fax:714-994-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty