Healthcare Provider Details

I. General information

NPI: 1326273343
Provider Name (Legal Business Name): IRENE C. CHANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 02/24/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E HUNTINGTON DR
ARCADIA CA
91006-3209
US

IV. Provider business mailing address

40 E HUNTINGTON DR
ARCADIA CA
91006-3209
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-0114
  • Fax: 626-577-0116
Mailing address:
  • Phone: 626-577-0114
  • Fax: 626-577-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number38815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: