Active NPI
Yun Shik Chang
- Dentist
- Roswell, NM
National Provider Identifier
1053897280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD4951
- Practice address
- 2600 N Main St
Roswell, NM 88201-6554 - Phone
- (888) 988-4066
- Fax
- (847) 496-4850
- NPI assigned
- Jul 11, 2018
- Last updated
- Jul 11, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DD4951 | NM | Primary |
Addresses
Primary practice location
2600 N Main St
Roswell, NM 88201-6554
Mailing address
2050 E Algonquin Rd Ste 610
Schaumburg, IL 60173-4166
Phone (888) 988-4066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180806001295 | NM | Order and Referring Only - Dentist | 1557619699 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Familia Dental Ros LLC | Past | Accepting new patients |
Organizations & group practices 1
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": "1531267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531267200000",
"number": "1053897280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 E ALGONQUIN RD STE 610",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601734166",
"telephone_number": "888-988-4066",
"fax_number": "847-496-4850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 N MAIN ST",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882016554",
"telephone_number": "888-988-4066",
"fax_number": "847-496-4850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "YUN SHIK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-11",
"last_updated": "2018-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD4951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.