Provider Demographics
NPI:1396718763
Name:CHANG, YOUNGJUNE (DDS)
Entity type:Individual
Prefix:
First Name:YOUNGJUNE
Middle Name:
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 1:6708 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-3021
Mailing Address - Country:US
Mailing Address - Phone:913-299-8554
Mailing Address - Fax:913-299-3187
Practice Address - Street 1:6708 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3021
Practice Address - Country:US
Practice Address - Phone:913-299-8554
Practice Address - Fax:913-299-3187
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice