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Individual
DR. RANDY CHANG
Active
Individual
DR. RANDY CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-025589
IL
1223G0001X
General Practice Dentistry
48587
CA
1223G0001X
General Practice Dentistry
DS7874
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019-025589
LICENSE #
IL
01
—
48587
LICENSE #
CA
01
—
73-1733714
FED TAX ID
—
01
—
DS7874
LICENSE #
TN
Enumeration date
06/22/2005
Last updated
03/07/2023
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