Healthcare Provider Details

I. General information

NPI: 1881859148
Provider Name (Legal Business Name): CAROLYN SOOJIN CHANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7671 QUARTERFIELD RD STE 400
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

3517 DOC BERLIN DR
SILVER SPRING MD
20906-1151
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-1212
  • Fax:
Mailing address:
  • Phone: 240-381-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000721
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14020
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: