=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194921916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J.C. CHANG, DMD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 11/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7011 ORANGETHORPE AVE. #100
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-994-4482
-----------------------------------------------------
Fax | 714-994-3995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7011 ORANGETHORPE AVE. #100
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-994-4482
-----------------------------------------------------
Fax | 714-994-3995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL JUNG-CHAN CHANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 714-994-4482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 39244
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------