Provider Demographics
NPI:1730415654
Name:CHANG HEALTHCARE ASSOCIATION, INC.
Entity type:Organization
Organization Name:CHANG HEALTHCARE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEI-YEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-461-3875
Mailing Address - Street 1:415 E CROSSVILLE RD
Mailing Address - Street 2:STE. A
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7626
Mailing Address - Country:US
Mailing Address - Phone:678-461-4875
Mailing Address - Fax:678-461-4877
Practice Address - Street 1:415 E CROSSVILLE RD
Practice Address - Street 2:STE. A
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7626
Practice Address - Country:US
Practice Address - Phone:678-461-4875
Practice Address - Fax:678-461-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0139741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty