Jin Sup Chang, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54978 Issued in CA

Practice address

400 Veterans Ave
Biloxi, MS 39531-2410

Phone

(228) 523-5103

Fax

(228) 523-4310

NPI assigned

Apr 17, 2008

Last updated

Jan 6, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388966400000",
    "number": "1679747885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 DOMINION DR",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645139",
            "telephone_number": "410-271-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 VETERANS AVE",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312410",
            "telephone_number": "228-523-5103",
            "fax_number": "228-523-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JIN",
        "middle_name": "SUP",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-17",
        "last_updated": "2014-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cedar Lake Pharmacy (Cedar Lake Pharmacy LLC.)
• Centerwell Senior Primary Care Ms CS PC
• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Biloxi)
• Aubri Challis
• Rickey L Chance, D.O.
• Changing Tides Counseling of Biloxi
• Charla Wilson Counseling Services, PLLC
• Charles Roberts LCSW & Associates LLC
• Jennifer Lynn Chatman Malley, NP
• Michael Chavis, D.P.M.

• General Practice Dentistry in Biloxi, MS
• Providers in Biloxi, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2014; 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.