Provider Demographics
NPI:1932288057
Name:RHIM, CHANG W (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:W
Last Name:RHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2224
Mailing Address - Country:US
Mailing Address - Phone:219-378-1450
Mailing Address - Fax:219-378-1450
Practice Address - Street 1:1730 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1415
Practice Address - Country:US
Practice Address - Phone:219-659-2776
Practice Address - Fax:219-370-0038
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010392A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200341740AMedicaid