Active NPI
Kiran Changa
- Periodontics
- Newark, NJ
National Provider Identifier
1902590821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DSO45611
- Practice address
- 110 Bergen St
Newark, NJ 07103-2495 - Phone
- (732) 991-7806
- NPI assigned
- Jun 5, 2023
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DSO45611 | PA | Primary |
Addresses
Primary practice location
110 Bergen St
Newark, NJ 07103-2495
Mailing address
8489 Country Club Dr Ste 4
North Huntingdon, PA 15642-4345
Phone (724) 817-3070
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 |
|---|---|---|---|
| DSO45611 | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779148800000",
"number": "1902590821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8489 COUNTRY CLUB DR STE 4",
"city": "NORTH HUNTINGDON",
"state": "PA",
"postal_code": "156424345",
"telephone_number": "724-817-3070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 BERGEN ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071032495",
"telephone_number": "732-991-7806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANGA",
"first_name": "KIRAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-05",
"last_updated": "2026-05-19",
"certification_date": "2026-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DSO45611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.