Provider Demographics
NPI:1285019059
Name:KIM, CHANG (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2576 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3417
Mailing Address - Country:US
Mailing Address - Phone:469-248-0012
Mailing Address - Fax:469-317-7120
Practice Address - Street 1:2576 ROYAL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3417
Practice Address - Country:US
Practice Address - Phone:469-248-0012
Practice Address - Fax:469-317-7120
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor