Provider Demographics
NPI:1871872887
Name:CHANG, CHRIS (DDS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 HAMNER AVE UNIT 707
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-1042
Mailing Address - Country:US
Mailing Address - Phone:951-325-4600
Mailing Address - Fax:951-325-4494
Practice Address - Street 1:5337 HAMNER AVE UNIT 707
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-1042
Practice Address - Country:US
Practice Address - Phone:951-325-4600
Practice Address - Fax:951-325-4494
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist