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General NPI Number Information
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NPI Number | 1184812190
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Entity Type | Individual
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Provider Name | THOMAS GILMER M. CHANG DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 455 E COLUMBIA ST
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City | LONG BEACH
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State | CA
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Zip | 90806-1620
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Country | US
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Telephone | 562-933-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 12531 NEDRA DR
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City | GRANADA HILLS
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State | CA
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Zip | 91344-1847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 15193
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License Number State | CA
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