Provider Demographics
NPI:1548475502
Name:CHANG, SANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 HUNTINGTON AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5988
Mailing Address - Country:US
Mailing Address - Phone:650-588-5822
Mailing Address - Fax:
Practice Address - Street 1:1405 HUNTINGTON AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5988
Practice Address - Country:US
Practice Address - Phone:650-588-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist