Healthcare Provider Details

I. General information

NPI: 1346443686
Provider Name (Legal Business Name): IRENE CHANG A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E HUNTINGTON DRIVE
ARCADIA CA
91006
US

IV. Provider business mailing address

40 E HUNTINGTON DRIVE
ARCADIA CA
91006
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 TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38815
License Number StateCA

VIII. Authorized Official

Name: DR. IRENE C CHANG
Title or Position: OWNER
Credential: DDS MS
Phone: 626-577-0114