Healthcare Provider Details

I. General information

NPI: 1811209125
Provider Name (Legal Business Name): DAVID CHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 SHOW PLACE DR SUITE 106
NAPERVILLE IL
60564-5062
US

IV. Provider business mailing address

161 E CHICAGO AVE #28G
CHICAGO IL
60611-2601
US

V. Phone/Fax

Practice location:
  • Phone: 630-778-0024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027803
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011241
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: