MEDICARE: VICTORIA CHANG DMD

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	122300000X	Dentist	61070878	WA

General Provider Information

NPI Number	:	1972112514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CHANG DMD

Provider Business Mailing Address
First Line	:	4437 41ST AVE SW UNIT A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4218
Country	:	US
Telephone Number	:	321-616-1235
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 41ST AVE SW UNIT A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4218
Country	:	US
Telephone Number	:	321-616-1235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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Directions to “ VICTORIA CHANG DMD” Practice Location

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