Provider Demographics
NPI:1730564493
Name:CHANG, SUK-HO
Entity type:Individual
Prefix:
First Name:SUK-HO
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:S
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2557 CHINO HILLS PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5103
Mailing Address - Country:US
Mailing Address - Phone:909-393-7500
Mailing Address - Fax:909-393-6222
Practice Address - Street 1:2557 CHINO HILLS PKWY STE C
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5103
Practice Address - Country:US
Practice Address - Phone:909-393-7500
Practice Address - Fax:909-393-6222
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist