Active NPI
Grace Yeeun Chang
- Pediatric Dentistry
- Phoenix, AZ
National Provider Identifier
1871174243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D012810
- Practice address
- 4717 E Ray Rd
Phoenix, AZ 85044-6230 - Phone
- (480) 755-4455
- NPI assigned
- Apr 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D012810 | AZ | Primary |
| General Practice Dentistry | 1223G0001X | DT2978 | HI |
Addresses
Primary practice location
4717 E Ray Rd
Phoenix, AZ 85044-6230
Mailing address
4717 E Ray Rd
Phoenix, AZ 85044-6230
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
| License | State | Type | Specialty |
|---|---|---|---|
| DT2978 | HI | MD | General Practice Dentistry |
| D012810 | AZ | MD | Pediatric Dentist |
Interoperability endpoints
- grace.chang.p1@direct.wcchc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780012800000",
"number": "1871174243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4717 E RAY RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850446230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4717 E RAY RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850446230",
"telephone_number": "480-755-4455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "GRACE",
"middle_name": "YEEUN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-17",
"last_updated": "2026-05-29",
"certification_date": "2026-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AZ",
"license": "D012810",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "DT2978",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.