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General NPI Number Information
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NPI Number | 1376951509
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Entity Type | Organization
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Legal Business Name | PAY-JIUAN CHANG, D.D.D., INC.
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 1045 E. VALLEY BLVD. A 207
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City | SAN GABRIEL
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State | CA
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Zip | 91776
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Country | US
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Telephone | 626-288-5985
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Fax | 626-288-8281
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Provider Business Mailing Address
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Address Line | 1045 E. VALLEY BLVD. A 207
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City | SAN GABRIEL
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State | CA
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Zip | 91776
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Country | US
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Telephone | 626-288-5985
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Fax | 626-288-8281
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PAY-JIUAN CHANG
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Credential | D.D.S.
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Telephone | 626-288-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37398
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License Number State | CA
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