Juliet Chang, DMD, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

107235 Issued in CA

Practice address

3801 Las Posas Rd Ste 205
Camarillo, CA 93010-1426

Phone

(805) 388-1730

NPI assigned

Oct 3, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 14, 2023 through Feb 14, 2027

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Wilgus & Hunter Business Partnership

  • Periodontics
  • Camarillo, CA
  • NPI 1174358550
  NPD
• Smyrna Modern Dentistry, PC

  • Dentist
  • Smyrna, TN
  • NPI 1669840211
  NPD (past)

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1629527593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 SPRING PARK RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930127734",
            "telephone_number": "818-825-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 LAS POSAS RD STE 205",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930101426",
            "telephone_number": "805-388-1730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Movie Row",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "TN",
            "postal_code": "371676532",
            "country_code": "US",
            "telephone_number": "615-930-9606",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1481 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022803",
            "country_code": "US",
            "telephone_number": "317-988-2492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "590 foothill drive",
            "address_purpose": "LOCATION",
            "city": "salt lake city",
            "state": "UT",
            "postal_code": "84148",
            "country_code": "US",
            "telephone_number": "801-584-1206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JULIET",
        "credential": "DMD, MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-03",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TN",
            "license": "11248",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "107235",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Chacon
• Angelica Johanna Cham
• Heather Chamberlin-Scholle, LCSW
• Jessica Nicole Chanas, MFT TRAINEE
• Emily Chane
• Robert S Chang
• Susan S. Chang, MD
• Ting Ting Chang
• Channel Island Obstetrics and Gynecologic Medical Group
• Channel Islands Oral and Maxillofacial Surgery

• Periodontics in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.