Provider Demographics
NPI:1841072709
Name:DIM, CIANG KHAN
Entity type:Individual
Prefix:
First Name:CIANG
Middle Name:KHAN
Last Name:DIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 INWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3511
Mailing Address - Country:US
Mailing Address - Phone:301-531-0845
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 105
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4402
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:703-237-2729
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician