Provider Demographics
NPI:1174731293
Name:CHANG, WESLEY K W (DDS)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:K W
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WESLEY
Other - Middle Name:K W
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1410 ANTIQUA LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3970
Mailing Address - Country:US
Mailing Address - Phone:650-571-7621
Mailing Address - Fax:
Practice Address - Street 1:380 20TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2221
Practice Address - Country:US
Practice Address - Phone:415-751-1115
Practice Address - Fax:415-751-1116
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist