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General NPI Number Information
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NPI Number | 1932611035
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Entity Type | Individual
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Provider Name | SOO JIN CHANG DMD
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Gender | Female
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 8501 LINCOLN BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-3501
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Country | US
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Telephone | 310-670-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 702 S SERRANO AVE APT 705
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City | LOS ANGELES
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State | CA
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Zip | 90005-7202
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Country | US
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Telephone | 213-910-4084
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 62433
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License Number State | CA
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