Provider Demographics
NPI:1871335364
Name:HEE JIN CHANG DDS, INC
Entity type:Organization
Organization Name:HEE JIN CHANG DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEE JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-823-0429
Mailing Address - Street 1:3201 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3392
Mailing Address - Country:US
Mailing Address - Phone:213-384-2828
Mailing Address - Fax:
Practice Address - Street 1:3201 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3392
Practice Address - Country:US
Practice Address - Phone:213-384-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental