Provider Demographics
NPI:1366599359
Name:CHANG, GERALD EUNKWANG (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EUNKWANG
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N LURING DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6841
Mailing Address - Country:US
Mailing Address - Phone:760-778-2777
Mailing Address - Fax:
Practice Address - Street 1:140 N LURING DR
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6841
Practice Address - Country:US
Practice Address - Phone:760-778-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice