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General NPI Number Information
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NPI Number | 1861005662
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Entity Type | Individual
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Provider Name | KEVIN CHUN HUI CHANG DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 1508 N RIVERSIDE DR
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City | ESPANOLA
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State | NM
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Zip | 87532-2064
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Country | US
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Telephone | 505-753-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MORGAN ST APT 509
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City | JERSEY CITY
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State | NJ
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Zip | 07302-6243
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Country | US
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Telephone | 617-710-4387
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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 | DD5314
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License Number State | NM
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