=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609131960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE CHANG DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 07/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8267 E SANTA ANA CANYON RD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92808-2270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-455-9668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1708 HAYES CT
-----------------------------------------------------
City | PLACENTIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92870-8430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTINE AN-HSUN CHANG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 626-862-1673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 50044
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------