MEDICARE: YOUNGJUNE CHANG DDS LLC

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	7139	KS

General Provider Information

NPI Number	:	1770688095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNGJUNE CHANG DDS LLC

Provider Business Mailing Address
First Line	:	6708 STATE AVENUE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102
Country	:	US
Telephone Number	:	913-299-8554
Fax Number	:	913-299-3187

Provider Business Practice Location Address
First Line	:	6708 STATE AVENUE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102
Country	:	US
Telephone Number	:	913-299-8554
Fax Number	:	913-299-3187

Authorized Official
Title or Position	:	OWNER DENTIST PRESIDENT
Name	:	DR. YOUNGJUNE CHANG
Credential	:	DDS
Telephone Number	:	913-299-8554

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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