| Doctor Name: | DR. CHANGRAE KIM |
| NPI Number: | 1083022149 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 006653 |
| Business Practice Address: | 6508 Grand Ave Maspeth, NY - 113782423 |
| Business Phone Number: | 9173593937 |
| Business Fax Number: | |
| Mailing Address: | 2 Bay Club Dr Apt 5x, BAYSIDE |
| State: | NY |
| Postal Code: | 113602921 |
| Phone Number: | 9173593937 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2014 |
| NPI Last Update Date: | 08/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 006653 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |