Individual provider Active NPI

Dillon Chang, DMD

  • Dentist
  • San Jose, CA
National Provider Identifier
1356920060
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
113688 Issued in CA
Practice address
827 Blossom Hill Rd Ste W3
San Jose, CA 95123-2701
Phone
(408) 224-2000
NPI assigned
Apr 8, 2021
Reactivated
Jul 1, 2022
Last updated
Sep 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 113688 CA Primary

Addresses

Primary practice location

827 Blossom Hill Rd Ste W3
San Jose, CA 95123-2701

Mailing address

1565 Poppy Way
Cupertino, CA 95014-5306

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
113688CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dhaliwal and Dhaliwal DDS, PLLC CurrentSince Feb 19, 2023 Accepting new patients
Dhaliwal, DDS, PLLC PastSince Jul 10, 2022 Accepting new patients
Dillon Chang DMD Inc Dentist Past Accepting new patients

Locations

10725 SE 256th St
Ste 1
Kent, WA 98030
Phone (253) 854-2714

Organizations & group practices 3

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": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1356920060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 POPPY WAY",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950145306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 BLOSSOM HILL RD STE W3",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951232701",
            "telephone_number": "408-224-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "DILLON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-08",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "deactivation_date": "2022-04-22",
        "reactivation_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "113688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; 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.