Active NPI
Kook-Jin Chang, D.D.S.
- General Practice Dentistry
- Bronx, NY
National Provider Identifier
1023237708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 52588
- Practice address
- 234 E. 149TH St.
Bronx, NY 10451 - Phone
- (718) 579-5396
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 52588 | CA | Primary |
Addresses
Primary practice location
234 E. 149TH St.
Bronx, NY 10451
Mailing address
1749 Grand Concourse
W2K
Bronx, NY 10453-8000
Phone (928) 380-5044
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G9801103 | Other | HEALTHY FAMILIES DELTA | |
| G9151801 | Other | CA | MEDI CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52588 | CA | MD | General Practice Dentistry |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GGAGDD/Endpoint/GGAGDD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466121600000",
"number": "1023237708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1749 GRAND CONCOURSE",
"address_2": "W2K",
"city": "BRONX",
"state": "NY",
"postal_code": "104538000",
"telephone_number": "928-380-5044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 E. 149TH ST.",
"city": "BRONX",
"state": "NY",
"postal_code": "10451",
"telephone_number": "718-579-5396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "KOOK-JIN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2016-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "52588",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY FAMILIES DELTA",
"identifier": "G9801103",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI CAL",
"identifier": "G9151801",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.