Active NPI
Michael W Chang, DDS
- General Practice Dentistry
- Lakewood, CO
National Provider Identifier
1215997218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8912
- Practice address
- 14405 W Colfax Ave # 142
Lakewood, CO 80401-3247 - Phone
- (720) 325-5989
- NPI assigned
- Mar 24, 2006
- Last updated
- Nov 2, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8912 | CO | Primary |
| General Practice Dentistry | 1223G0001X | 22DI02267600 | NJ | |
| General Practice Dentistry | 1223G0001X | 051348 | NY | |
| General Practice Dentistry | 1223G0001X | 13993 | MD | |
| General Practice Dentistry | 1223G0001X | 0401412359 | VA | |
| General Practice Dentistry | 1223G0001X | DEN1000810 | DC |
Addresses
Primary practice location
14405 W Colfax Ave # 142
Lakewood, CO 80401-3247
Mailing address
14405 W Colfax Ave # 142
Lakewood, CO 80401-3247
Phone (720) 325-5989
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02558294 | Other | NY | NEW YORK MEDICAID |
| 74405519 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- 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 |
|---|---|---|---|---|
| I20160426000489 | OK | Order and Referring Only - Dentist | 4284933284 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8912 | CO | MD | General Practice Dentistry |
| DEN1000810 | DC | MD | General Practice Dentistry |
| 13993 | MD | MD | General Practice Dentistry |
| 22DI02267600 | NJ | MD | General Practice Dentistry |
| 0401412359 | VA | MD | General Practice Dentistry |
| 051348 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446422400000",
"number": "1215997218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14405 W COLFAX AVE # 142",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "804013247",
"telephone_number": "720-325-5989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14405 W COLFAX AVE # 142",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "804013247",
"telephone_number": "720-325-5989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "MICHAEL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2015-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "8912",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02267600",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "051348",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "13993",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401412359",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "DC",
"license": "DEN1000810",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK MEDICAID",
"identifier": "02558294",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "74405519",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; 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.