Philip Chang DDS Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PHILIP CHANG DDS DENTAL CORPORATION

Practice address

1611 Crenshaw Blvd Ste C
Torrance, CA 90501-7124

Phone

(310) 791-7108

Fax

(310) 791-7142

NPI assigned

Jan 13, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Philip Minsuk Chang, DDSNPI 1588771505

Title

Ceo

Phone

(424) 731-7096

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Create Smiles Dental Doing business as

Electronic endpoints 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Minsuk Chang, D.D.S.

  • Dentist
  • Torrance, CA
  • NPI 1588771505
  NPD Authorized official
• Lydia M Pak, D.D.S.

  • Dentist
  • Torrance, CA
  • NPI 1306030200
  NPD (past)

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1245870765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 CRENSHAW BLVD STE C",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905017124",
            "telephone_number": "424-731-7096",
            "fax_number": "424-731-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 CRENSHAW BLVD STE C",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905017124",
            "telephone_number": "310-791-7108",
            "fax_number": "310-791-7142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP CHANG DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "MINSUK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "424-731-7096",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL",
            "identifier": "51048",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Torrance",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3640 Lomita Blvd Ste 207",
            "city": "Torrance",
            "state": "CA",
            "country_code": "US",
            "postal_code": "905053954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Torrance",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Torrance",
            "address_1": "1611 Crenshaw Blvd Ste C",
            "city": "Torrance",
            "state": "CA",
            "country_code": "US",
            "postal_code": "905017124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Create Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristina Phan, DO
• Ryan Cao Vinh Phan, MD
• Trina Phan, PHARM.D
• Yen Phan
• Pharmco Inc
• Philip G. Marais, DDS
• Philip Logiudice, MD Inc
• Beena P Philipose
• Janet Susan Philips, PHD
• Megan Philips

• Dental Clinic/Center in Torrance, CA
• Providers in Torrance, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.