Basic Information
| Provider Information | |||||||||
| NPI: | 1972528941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | HUBERT | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16377 LAS CUMBRES DR | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906031139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146754817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6301 BEACH BLVD STE 109 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146754817 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | DC25672 | CA | Y | Chiropractic Providers | Chiropractor | Sports Physician |
ID Information
| ID | Type | State | Issuer | Description | ZZZ66234Z | 01 | CA | INSURANCE | OTHER | DC0256720 | 05 | CA | MEDICAID |