Individual provider Active NPI

Michael W Chang, DDS

  • General Practice Dentistry
  • Lakewood, CO
National Provider Identifier
1215997218
Registry record updated Nov 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8912 Issued in CO
Practice address
14405 W Colfax Ave # 142
Lakewood, CO 80401-3247
Phone
(720) 325-5989
NPI assigned
Mar 24, 2006
Last updated
Nov 2, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2015

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
02558294OtherNYNEW YORK MEDICAID
74405519MedicaidCO

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160426000489 OK Order and Referring Only - DentistPractitioner - Dentist 4284933284

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8912COMDGeneral Practice Dentistry
DEN1000810DCMDGeneral Practice Dentistry
13993MDMDGeneral Practice Dentistry
22DI02267600NJMDGeneral Practice Dentistry
0401412359VAMDGeneral Practice Dentistry
051348NYMDPharmacist

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

Verify at the official NPI Registry.