Provider Demographics
NPI:1144871559
Name:SEAN WONHYUNG CHANG
Entity type:Organization
Organization Name:SEAN WONHYUNG CHANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-733-8011
Mailing Address - Street 1:4902 IRVINE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3335
Mailing Address - Country:US
Mailing Address - Phone:949-733-8011
Mailing Address - Fax:
Practice Address - Street 1:4902 IRVINE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3335
Practice Address - Country:US
Practice Address - Phone:949-733-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101318OtherDENTIST