=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619981453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS CHANG AND STRONG DDS. PA.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 S EDGEMOOR ST BUILDING 400
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-267-3924
-----------------------------------------------------
Fax | 316-262-0754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 S EDGEMOOR ST BUILDING 400
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-267-3924
-----------------------------------------------------
Fax | 316-262-0754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH PATRICK CHANG
-----------------------------------------------------
Credential | DDS.
-----------------------------------------------------
Telephone | 316-267-3924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6217
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------