Provider Demographics
NPI:1144511015
Name:CHANG, CHAN ALEXANDRA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHAN
Middle Name:ALEXANDRA
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:19280 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2504
Mailing Address - Country:US
Mailing Address - Phone:916-849-8998
Mailing Address - Fax:
Practice Address - Street 1:19280 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2504
Practice Address - Country:US
Practice Address - Phone:916-849-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics