Provider Demographics
NPI:1932288057
Name:RHIM, CHANG W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:W
Last Name:RHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 S HOHMAN AVE
Mailing Address - Street 2:LC
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1965
Mailing Address - Country:US
Mailing Address - Phone:219-378-1450
Mailing Address - Fax:773-768-2627
Practice Address - Street 1:5500 S HOHMAN AVE
Practice Address - Street 2:LC
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1965
Practice Address - Country:US
Practice Address - Phone:219-378-1450
Practice Address - Fax:773-768-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010392A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice