Individual
CHANG KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1971 MCCULLOCH BLVD N STE 100, LAKE HAVASU CITY, AZ 86403-6118
(928) 733-6070
Mailing address
2095 MESQUITE AVE UNIT 23, LAKE HAVASU CITY, AZ 86403-6749
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009530
AZ
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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