Healthcare Provider Details

I. General information

NPI: 1225351836
Provider Name (Legal Business Name): KHK DENTISRTY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 LONG BEACH RD
OCEANSIDE NY
11572
US

IV. Provider business mailing address

2812 LONG BEACH RD
OCEANSIDE NY
11572
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-5340
  • Fax: 516-536-5383
Mailing address:
  • Phone: 516-536-5340
  • Fax: 516-536-5383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: HYUN CHANG
Title or Position: DENTIST
Credential: D.D.S.
Phone: 516-536-5340