MEDICARE: PEARLINE YING-FONG CHANG D.D.S., M.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	1223P0221X	Pediatric Dentistry	53979	CA

General Provider Information

NPI Number	:	1477865061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARLINE YING-FONG CHANG D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3980 SAN PABLO DAM ROAD
Second Line	:	STE 100
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-2840
Country	:	US
Telephone Number	:	510-222-1441
Fax Number	:	510-223-2317

Provider Business Practice Location Address
First Line	:	3980 SAN PABLO DAM ROAD
Second Line	:	STE 100
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-2840
Country	:	US
Telephone Number	:	510-222-1441
Fax Number	:	510-223-2317

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	07/12/2010

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