Individual
JEFFREY CHANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
140 E MAIN ST, OTHELLO, WA 99344-1040
(650) 575-7594
Mailing address
140 E MAIN ST, OTHELLO, WA 99344-1040
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RR60583726
WA
Other
Enumeration date
02/15/2016
Last updated
02/22/2016
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