MEDICARE: CHANGSOO RHIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	218950	NY

General Provider Information

NPI Number	:	1700910825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANGSOO RHIM M.D.

Provider Business Mailing Address
First Line	:	331 PACIFIC ST
Second Line	:	APT.3
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6335
Country	:	US
Telephone Number	:	917-572-5872
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5706
Country	:	US
Telephone Number	:	718-239-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/15/2014

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