Active NPI
Paul C. Chang, DDS
- Dentist
- Upland, CA
National Provider Identifier
1760698914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 32540
- Practice address
- 600 N Mountain Ave
D-205
Upland, CA 91786-4359 - Phone
- (909) 985-9866
- NPI assigned
- May 15, 2007
- Last updated
- Aug 23, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 32540 | CA | Primary |
Addresses
Primary practice location
600 N Mountain Ave
D-205
Upland, CA 91786-4359
Mailing address
600 N Mountain Ave
D-205
Upland, CA 91786-4359
Phone (909) 985-9866
Other practice location 1
1074 Park View Dr Ste 201
Covina, CA 91724-3749
Phone (626) 332-3045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151209002249 | CA | Order and Referring Only - Dentist | 4385945757 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32540 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paul C Chang Dental Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Upland, CA
- NPI 1073617445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661212800000",
"number": "1760698914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 N MOUNTAIN AVE",
"address_2": "D-205",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864359",
"telephone_number": "909-985-9866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N MOUNTAIN AVE",
"address_2": "D-205",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864359",
"telephone_number": "909-985-9866"
}
],
"practiceLocations": [
{
"address_1": "1074 Park View Dr Ste 201",
"address_purpose": "LOCATION",
"city": "Covina",
"state": "CA",
"postal_code": "917243749",
"country_code": "US",
"telephone_number": "626-332-3045",
"fax_number": "626-332-2281",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHANG",
"first_name": "PAUL",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2022-08-23",
"certification_date": "2022-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "32540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.