Provider Demographics
NPI:1144313297
Name:CHANG, JASON H (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:H
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 1:1229 146TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5515
Mailing Address - Country:US
Mailing Address - Phone:206-579-0161
Mailing Address - Fax:
Practice Address - Street 1:1101 AVENUE D
Practice Address - Street 2:C104
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2083
Practice Address - Country:US
Practice Address - Phone:425-252-1188
Practice Address - Fax:425-258-2928
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE90011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice