Provider Demographics
NPI:1033291653
Name:CHANG, KIMBERLY H (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:H
Last Name:CHANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SOUTH ST
Mailing Address - Street 2:SOUTH COVE COMMUNITY HEALTH CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2826
Mailing Address - Country:US
Mailing Address - Phone:617-521-6760
Mailing Address - Fax:671-521-6795
Practice Address - Street 1:145 SOUTH ST
Practice Address - Street 2:SOUTH COVE COMMUNITY HEALTH CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2826
Practice Address - Country:US
Practice Address - Phone:617-521-6760
Practice Address - Fax:671-521-6795
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19041122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist