Provider Demographics
NPI:1821134842
Name:SIM, CHANG UK (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:UK
Last Name:SIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2716 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3143
Mailing Address - Country:US
Mailing Address - Phone:347-563-2975
Mailing Address - Fax:
Practice Address - Street 1:656 W 183RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3806
Practice Address - Country:US
Practice Address - Phone:212-795-2261
Practice Address - Fax:212-795-2671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist