Physician Compare National (NPI:1780036475)

HEALTHCARE PROVIDER: CHANG KIM D.M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1780036475
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345578548
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190918003007
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	CHANG
	Individual professional first name
Provider Middle Name	Y
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE, GLENDALE
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	DENTIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1325 W 16TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	YUMA
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	853644496
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y