MEDICARE: SUKYONG CHANG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-026331	IL

General Provider Information

NPI Number	:	1053316752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKYONG CHANG D.D.S.

Provider Business Mailing Address
First Line	:	4801 W PETERSON AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5726
Country	:	US
Telephone Number	:	773-777-8686
Fax Number	:	773-777-8688

Provider Business Practice Location Address
First Line	:	4801 W PETERSON AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5726
Country	:	US
Telephone Number	:	773-777-8686
Fax Number	:	773-777-8688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/07/2025

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Directions to “ SUKYONG CHANG D.D.S.” Practice Location

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