Chang Kim, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D009530 Issued in AZ

Practice address

1971 McCulloch Blvd N Ste 100
Lake Havasu City, AZ 86403-6118

Phone

(928) 733-6070

NPI assigned

Jul 6, 2016

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)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Havasu Dentistry

  • General Practice Dentistry
  • Lake Havasu City, AZ
  • NPI 1396198263
  NPD (past)

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467763200000",
    "number": "1780036475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 MESQUITE AVE UNIT 23",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 MCCULLOCH BLVD N STE 100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036118",
            "telephone_number": "928-733-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHANG",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-06",
        "last_updated": "2016-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D009530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Kent, OCCUPATIONAL THERAPI
• Kevin Eugene Keough
• Ezekiel Keereng Kesitilwe, PHARMD
• Kevin J Obrien DPM Inc
• Ronald Bernard Killian, DPM
• Cheryl M Kingsbury, MS, OTR/L
• Deborah Ann Kinzer, D.D.S.
• Kaleigh-Jo Taylor Kirby, PA
• Justin Kirch, D.D.S.
• John Harlan Kitterman IV, MS, ATC

• General Practice Dentistry in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.