Healthcare Provider Details

I. General information

NPI: 1598930398
Provider Name (Legal Business Name): KYUNG HEE CHANG M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ROCHE BROTHERS WAY STE 200
NORTH EASTON MA
02356-1032
US

IV. Provider business mailing address

12 TWIN POST RD
WESTWOOD MA
02090-2768
US

V. Phone/Fax

Practice location:
  • Phone: 508-535-3376
  • Fax: 508-535-3377
Mailing address:
  • Phone: 508-535-3376
  • Fax: 508-535-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number237853
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number237853
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: