Healthcare Provider Details

I. General information

NPI: 1356920060
Provider Name (Legal Business Name): DILLON CHANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 04/22/2022
Reactivation Date: 07/01/2022

III. Provider practice location address

827 BLOSSOM HILL RD STE W3
SAN JOSE CA
95123-2701
US

IV. Provider business mailing address

1565 POPPY WAY
CUPERTINO CA
95014-5306
US

V. Phone/Fax

Practice location:
  • Phone: 408-224-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: