Provider Demographics
NPI:1992821086
Name:CHANG, DANIEL DOOYONG (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DOOYONG
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 1:200 SW 41ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4917
Mailing Address - Country:US
Mailing Address - Phone:425-251-8000
Mailing Address - Fax:425-251-6174
Practice Address - Street 1:200 SW 41ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4917
Practice Address - Country:US
Practice Address - Phone:425-251-8000
Practice Address - Fax:425-251-6174
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice