MEDICARE: PHILIP CHANG, DDS, INC.

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	122300000X	Dentist	62595	CA

General Provider Information

NPI Number	:	1386013209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP CHANG, DDS, INC.

Provider Business Mailing Address
First Line	:	18208 VILLA CLARA ST
Second Line	:
City	:	ROWLAND HGHTS
State	:	CA
Zip	:	91748-4435
Country	:	US
Telephone Number	:	626-217-4542
Fax Number	:

Provider Business Practice Location Address
First Line	:	8038 GARVEY AVE STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2483
Country	:	US
Telephone Number	:	626-571-7000
Fax Number	:	626-571-8454

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP CHANG
Credential	:	D.D.S.
Telephone Number	:	626-217-4542

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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