Healthcare Provider Details

I. General information

NPI: 1790827152
Provider Name (Legal Business Name): ANDREW K CHANG DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 ERMA RD STE100
SAN DIEGO CA
92131-1007
US

IV. Provider business mailing address

9855 ERMA RD STE100
SAN DIEGO CA
92131-1007
US

V. Phone/Fax

Practice location:
  • Phone: 858-536-2900
  • Fax: 858-271-0529
Mailing address:
  • Phone: 858-536-2900
  • Fax: 858-271-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: