1174731293 NPI number — DR. WESLEY K. W. CHANG DDS

Table of content: DR. WESLEY K. W. CHANG DDS (NPI 1174731293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174731293 NPI number — DR. WESLEY K. W. CHANG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
WESLEY
Provider Middle Name:
K. W.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHANG
Provider Other First Name:
WESLEY
Provider Other Middle Name:
K. W.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174731293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 ANTIQUA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSTER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404-3970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-571-7621
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 20TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94121-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-751-1115
Provider Business Practice Location Address Fax Number:
415-751-1116
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  032812 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)