Randy Chang, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-025589 Issued in IL

Practice address

916 N Green Bay Rd
Waukegan, IL 60085-2240

Phone

(847) 336-8200

Fax

(847) 336-8203

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Dr. Randolph Chang Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advantage Dental Care, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1295890705

  General Practice

  NPD (past) Authorized official
• Advantage Dental Care, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1679646962

  General Practice

  NPD (past) Authorized official
• Midwest Family Dental, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1497027015

  General Practice

  NPD (past) Authorized official
• JC Dental Care

  • Dentist
  • Chicago, IL
  • NPI 1740525260
  NPD (past)
• Midwest Family Dental, LLC

  • Dentist
  • Waukegan, IL
  • NPI 1508268053
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1013913342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 N WESTERN AVE",
            "address_2": "STE J",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606451833",
            "telephone_number": "773-338-8433",
            "fax_number": "773-338-8434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 N GREEN BAY RD",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852240",
            "telephone_number": "847-336-8200",
            "fax_number": "847-336-8203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 N California Ave Ste 5",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606476320",
            "country_code": "US",
            "telephone_number": "773-772-8001",
            "fax_number": "773-772-8033",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2843 W Irving Park Rd",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606183624",
            "country_code": "US",
            "telephone_number": "773-267-8600",
            "fax_number": "773-267-8601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7300 N Western Ave",
            "address_2": "Ste J",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606451833",
            "country_code": "US",
            "telephone_number": "773-338-8433",
            "fax_number": "773-338-8434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "RANDY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48587",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS7874",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-025589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED TAX ID",
            "identifier": "73-1733714",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "019-025589",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "DS7874",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "48587",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RANDOLPH",
            "last_name": "CHANG",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Laura Centrella, LCPC
• Shawn E Cesario, RN
• Sooyeon Cha
• Michael Austin Chambers
• Jieun Priscilla Chang, LPC
• Alicia Lynn Chatterton
• Ryan Nicholas Chellin, D.O.
• Ronald Cheng, DDS
• Evelyn C Chenier
• Sung A Cheon, M.D.

• All providers in Waukegan, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.