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General NPI Number Information
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NPI Number | 1902442767
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Entity Type | Individual
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Provider Name | EDWARD JOHN CHANG DDS
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Gender | Male
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 3907 PRINCE ST STE 5E
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City | FLUSHING
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State | NY
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Zip | 11354-5308
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Country | US
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Telephone | 718-461-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 99 JOHN ST APT 222
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City | NEW YORK
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State | NY
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Zip | 10038-2902
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Country | US
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Telephone | 516-779-0014
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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 | 22DI002744400
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License Number State | NJ
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