Healthcare Provider Details

I. General information

NPI: 1518539774
Provider Name (Legal Business Name): MARY JOOEUN CHANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 132ND ST SE STE G
EVERETT WA
98208-7203
US

IV. Provider business mailing address

1519 132ND ST SE STE G
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 425-616-3729
  • Fax:
Mailing address:
  • Phone: 425-616-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70083726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: