MEDICARE: CHRIS H. CHANG DDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1285147926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS H. CHANG DDS, INC

Provider Business Mailing Address
First Line	:	5337 HAMNER AVE UNIT 707
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	91752-1042
Country	:	US
Telephone Number	:	951-325-4600
Fax Number	:	951-325-4494

Provider Business Practice Location Address
First Line	:	5337 HAMNER AVE UNIT 707
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	91752-1042
Country	:	US
Telephone Number	:	951-444-8164
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHRIS CHANG
Credential	:	DDS
Telephone Number	:	951-325-4600

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/04/2020

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