Provider Demographics
NPI:1417398405
Name:YIM, CHANG MIN RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANG MIN
Middle Name:RICHARD
Last Name:YIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5405
Mailing Address - Country:US
Mailing Address - Phone:215-840-5782
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN ST # B854
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-7462
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD16977204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery