MEDICARE: DR. EVAN Y 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	1223P0221X	Pediatric Dentistry	103086	CA

General Provider Information

NPI Number	:	1699127266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN Y CHANG DDS

Provider Business Mailing Address
First Line	:	1844 MARKET ST UNIT 208
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6288
Country	:	US
Telephone Number	:	310-938-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2035
Country	:	US
Telephone Number	:	310-938-0423
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	12/14/2023

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