Provider Demographics
NPI:1598930398
Name:CHANG, KYUNG HEE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG HEE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TWIN POST RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2768
Mailing Address - Country:US
Mailing Address - Phone:508-535-3376
Mailing Address - Fax:508-535-3377
Practice Address - Street 1:31 ROCHE BROTHERS WAY STE 200
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1032
Practice Address - Country:US
Practice Address - Phone:508-535-3376
Practice Address - Fax:508-535-3377
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237853207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKC75976Medicaid
RIKC75976Medicaid