MEDICARE: DR. LAUREN CHANG DDS

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	102670	CA

General Provider Information

NPI Number	:	1487134813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN CHANG DDS

Provider Business Mailing Address
First Line	:	190 EMERALD WAY
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1755
Country	:	US
Telephone Number	:	510-691-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 POLK ST STE D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2549
Country	:	US
Telephone Number	:	510-691-8638
Fax Number	:

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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