Healthcare Provider Details

I. General information

NPI: 1487335733
Provider Name (Legal Business Name): PAUL S CHANG DENTAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 FOOTHILL BLVD UNIT 250
RANCHO CUCAMONGA CA
91730-3754
US

IV. Provider business mailing address

10470 FOOTHILL BLVD UNIT 250
RANCHO CUCAMONGA CA
91730-3754
US

V. Phone/Fax

Practice location:
  • Phone: 626-818-0633
  • Fax:
Mailing address:
  • Phone: 626-818-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL S CHANG
Title or Position: CEO
Credential: DMD
Phone: 626-818-0633