Healthcare Provider Details

I. General information

NPI: 1164348108
Provider Name (Legal Business Name): RYAN CHANG, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W 7TH ST
SAN PEDRO CA
90732-3516
US

IV. Provider business mailing address

1490 W 7TH ST
SAN PEDRO CA
90732-3516
US

V. Phone/Fax

Practice location:
  • Phone: 818-522-5958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RYAN CHANG
Title or Position: PRESIDENT
Credential:
Phone: 818-522-5958