=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598880726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HERMAN CHANG D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1704 MIRAMONTE AVE STE 9
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-964-3257
-----------------------------------------------------
Fax | 650-964-9760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1704 MIRAMONTE AVE STE 9
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-964-3257
-----------------------------------------------------
Fax | 650-964-9760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 43689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------