MEDICARE: DR. JACK C 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	53582	CA

General Provider Information

NPI Number	:	1386769925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK C CHANG D.D.S

Provider Business Mailing Address
First Line	:	6804 HIGHWAY 6 S STE H
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-3397
Country	:	US
Telephone Number	:	281-495-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6804 HIGHWAY 6 S STE H
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-3397
Country	:	US
Telephone Number	:	281-495-4100
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/19/2022

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