Provider Demographics
NPI:1902330400
Name:KIM, CHANG YONG (DPM)
Entity type:Individual
Prefix:
First Name:CHANG YONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4701 RANDOLPH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2260
Mailing Address - Country:US
Mailing Address - Phone:240-206-6274
Mailing Address - Fax:240-599-4344
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2257
Practice Address - Country:US
Practice Address - Phone:240-206-6274
Practice Address - Fax:240-599-4344
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD01780213E00000X
VA0103301376213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist