Provider Demographics
NPI:1972528941
Name:CHANG, HUBERT KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:KIM
Last Name:CHANG
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 1:16377 LAS CUMBRES DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-1139
Mailing Address - Country:US
Mailing Address - Phone:714-675-4817
Mailing Address - Fax:
Practice Address - Street 1:6301 BEACH BLVD STE 109
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4030
Practice Address - Country:US
Practice Address - Phone:714-675-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25672111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66234ZOtherINSURANCE
CADC0256720Medicaid
CADC0256720Medicaid
CAWDC25672EMedicare PIN
CAZZZ66234ZOtherINSURANCE