Chang Nam Kim, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA03826200 Issued in NJ

Practice address

22 Woodstone Dr
Cedar Grove, NJ 07009-1940

Phone

(973) 773-9228

Fax

(973) 857-3123

NPI assigned

Sep 7, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1063516458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WOODSTONE DR",
            "city": "CEDAR GROVE",
            "state": "NJ",
            "postal_code": "070091940",
            "telephone_number": "973-773-9228",
            "fax_number": "973-773-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 WOODSTONE DR",
            "city": "CEDAR GROVE",
            "state": "NJ",
            "postal_code": "070091940",
            "telephone_number": "973-773-9228",
            "fax_number": "973-857-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHANG",
        "middle_name": "NAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA03826200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "A62478",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Taylor Jasmin, LAC, NCC
• Alyssa Maria Kees
• Kimberly A Kerney, M.S. CCC-SLP, PC
• Mina Khouzam, PHARM D
• Tara Brooke Kiernan
• Annie Elizabeth Klinger, P.T.
• Mary E Ko, DPT
• Patricia Konstantaros, APN
• Dandee Rey Lacuesta
• Gina Maria Laporta, DC

• Psychiatry Physician in Cedar Grove, NJ
• Providers in Cedar Grove, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.