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General NPI Number Information
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NPI Number | 1558978957
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Entity Type | Individual
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Provider Name | TIEN-HSIN CHANG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 240 S 40TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-6030
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Country | US
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Telephone | 215-898-8964
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Fax |
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Provider Business Mailing Address
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Address Line | ONE KNEELAND STREET, 12 FLOOR, PERIODONTOLOGY CLINIC
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 617-459-0481
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | RFD000066
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License Number State | PA
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