Healthcare Provider Details

I. General information

NPI: 1750710133
Provider Name (Legal Business Name): ANDY CHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S EL MOLINO AVE SUITE #5
PASADENA CA
91101-2564
US

IV. Provider business mailing address

175 S EL MOLINO AVE SUITE #5
PASADENA CA
91101-2564
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-3636
  • Fax: 626-844-3633
Mailing address:
  • Phone: 626-844-3636
  • Fax: 626-844-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: