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General NPI Number Information
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NPI Number | 1760662209
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Entity Type | Individual
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Provider Name | ALICIA CHANG
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 6850 LINCOLN AVE SUITE 101
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City | BUENA PARK
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State | CA
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Zip | 90620-4178
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Country | US
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Telephone | 714-995-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2729 PEPPERDALE DR
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-4933
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Country | US
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Telephone | 213-327-4648
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 56265
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License Number State | CA
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