Individual provider Active NPI

Jeff Chang, DDS

  • Dentist
  • North Bergen, NJ
National Provider Identifier
1093276073
Registry record updated Oct 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI02802200 Issued in NJ
Practice address
8407 Kennedy Blvd
North Bergen, NJ 07047-4338
Phone
(201) 868-2747
Fax
(201) 295-8475
NPI assigned
Mar 30, 2019
Last updated
Oct 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI02802200 NJ Primary

Addresses

Primary practice location

8407 Kennedy Blvd
North Bergen, NJ 07047-4338

Mailing address

8407 Kennedy Blvd
North Bergen, NJ 07047-4338

Other practice location 1

2500 Lemoine Ave Ste 403
Fort Lee, NJ 07024-6232
Phone (201) 399-4860

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
22DI02802200NJMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
J&B Dental Group LLC Dentist CurrentSince Jul 2, 2023 Accepting new patients
Jamil El Samna DDS Dentist PastSince Jan 31, 2021 Accepting new patients

Locations

2500 Lemoine Ave
Ste 403
Fort Lee, NJ 07024
Phone (201) 399-4860

Organizations & group practices 2

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": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696723200000",
    "number": "1093276073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8407 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070474338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8407 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070474338",
            "telephone_number": "201-868-2747",
            "fax_number": "201-295-8475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Lemoine Ave Ste 403",
            "address_purpose": "LOCATION",
            "city": "Fort Lee",
            "state": "NJ",
            "postal_code": "070246232",
            "country_code": "US",
            "telephone_number": "201-399-4860",
            "fax_number": "201-399-4868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JEFF",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-30",
        "last_updated": "2023-10-08",
        "certification_date": "2023-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02802200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2023; 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.