CHANG KIM (NPI# 1780036475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780036475 |
| Entity Type | Individual |
| Full Name | CHANG KIM |
| Credential | D.M.D. |
| Practice Address |
1971 Mcculloch Blvd N Ste 100 Lake Havasu City AZ 86403-6118 |
| Mailing Address |
2095 Mesquite Ave Unit 23 Lake Havasu City AZ 86403-6749 |
| Practice Telephone | 9287336070 |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D009530 | AZ | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285019059 | Chang Kim | Chiropractor | 2576 Royal Ln, Dallas, TX 75229-3417 | 2015-07-22 |
| 1902242258 | Chang Sung Kim | Chiropractor | 2391 Bell Blvd Ste 205, Bayside, NY 11360-2019 | 2013-05-14 |
| 1528373511 | Chang H. Kim | Acupuncturist | 9401 Mathy Dr Ste 100, Fairfax, VA 22031 | 2010-08-13 |
| 1568641199 | Chang K Kim | Acupuncturist | 326 Reservation Rd, Suite E, Marina, CA 93933-3257 | 2007-10-31 |
| 1063516458 | Chang Nam Kim | Psychiatry & Neurology | 1200 Us Highway 46, Clifton, NJ 07013-2440 | 2006-09-07 |
| 1104883768 | Chang Kwon Kim | Surgery | 0n300 Armstrong Ln, Geneva, IL 60134-6081 | 2006-04-27 |
| 1477971430 | Chang Hoon Kim | Internal Medicine | 2500 Metrohealth Dr, Cleveland, OH 44109-1900 | 2014-04-06 |
| 1447375340 | Chang W Kim | Psychiatry & Neurology | 1500 Waters Pl, Bronx, NY 10461-2723 | 2007-03-20 |
| 1942339676 | Chang Choo Kim | Counselor | 35425 W Michigan Ave, Wayne, MI 48184-1687 | 2007-03-06 |
| 1720152507 | Chang O. Kim | Orthopaedic Surgery | 80 Grand Ave, 5th Floor, Oakland, CA 94612-3725 | 2006-11-20 |
| Street Address |
1971 MCCULLOCH BLVD N STE 100 |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-6118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114419439 | Ryan Michael Kurtz | Dentist | 1971 Mcculloch Blvd N Ste 100, Lake Havasu City, AZ 86403-6118 | 2018-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720648272 | Erica R. Houston | Dentist | 101 Riviera Dr, Lake Havasu City, AZ 86403-5736 | 2019-06-17 |
| 1194385724 | Cameron Lundin | Dentist | 1741 Mesquite Ave Ste 100b, Lake Havasu City, AZ 86403-5686 | 2019-06-17 |
| 1174839328 | Jason Yole | Dentist | 2167 Birch Square Ste D, Lake Havasu City, AZ 86403 | 2010-08-25 |
| 1699931691 | Richard Ryan Coburn | Dentist | 80 Acoma Blvd, Lake Havasu City, AZ 86403 | 2008-07-30 |
| 1003007956 | Aesthetic Dental Care of Arizona, P.C. | Dentist | 34 Lake Havasu Ave N, Suite 5, Lake Havasu City, AZ 86403-5638 | 2007-08-06 |
| 1508983867 | Don F Christie | Dentist | 1068 Vista Dr, Lake Havasu City, AZ 86404-9516 | 2007-03-23 |
| 1528106093 | Deborah Ann Kinzer | Dentist | 2167 Birch Sq, Suite #d, Lake Havasu City, AZ 86403-6671 | 2007-02-04 |
| 1497818652 | Julia E. Carlson | Dentist | 2580 Kiowa Blvd N, Lake Havasu City, AZ 86403-2551 | 2006-12-19 |
| 1700956562 | Edward B Ahn | Dentist | 1680 Mcculloch Blvd N, Lake Havasu City, AZ 86403-0962 | 2006-11-09 |
| 1669559357 | Dee Dennis Moshos Sr. | Dentist | 34 Lake Havasu Ave N Ste 5, Lake Havasu City, AZ 86403-5639 | 2006-11-01 |
| Find all providers in LAKE HAVASU CITY | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
Please comment or provide details below to improve the information on CHANG KIM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.