Individual provider Active NPI

Sukyong Chang, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1053316752
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-026331 Issued in IL
Practice address
4801 W Peterson Ave Ste 309
Chicago, IL 60646-5726
Phone
(773) 777-8686
Fax
(773) 777-8688
NPI assigned
Jun 17, 2005
Last updated
Oct 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019-026331 IL Primary

Addresses

Primary practice location

4801 W Peterson Ave Ste 309
Chicago, IL 60646-5726

Mailing address

4801 W Peterson Ave Ste 309
Chicago, IL 60646-5726
Phone (773) 777-8686

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

LicenseStateTypeSpecialty
019-026331ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Town Line Dental Care General Practice Past Accepting new patients
Plus Dental General Practice PastSince Oct 12, 2025 Accepting new patients
Gelena Roytman DDS LTD General Practice PastSince Jul 31, 2022 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1053316752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE STE 309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465726",
            "telephone_number": "773-777-8686",
            "fax_number": "773-777-8688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE STE 309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465726",
            "telephone_number": "773-777-8686",
            "fax_number": "773-777-8688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "SUKYONG",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-026331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.