Provider Demographics
NPI:1013014620
Name:CHOI, CHANG HYUK (MD)
Entity Type:Individual
Prefix:
First Name:CHANG
Middle Name:HYUK
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANG
Other - Middle Name:CHOI
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:208 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1160
Mailing Address - Country:US
Mailing Address - Phone:304-343-4300
Mailing Address - Fax:304-343-5473
Practice Address - Street 1:208 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1160
Practice Address - Country:US
Practice Address - Phone:304-343-4300
Practice Address - Fax:304-343-5473
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13240207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070730000Medicaid
CH4045224Medicare ID - Type UnspecifiedPARKERSBURG WV OFFICE
WV0070730000Medicaid
E27192Medicare UPIN
CH4045226Medicare ID - Type UnspecifiedLOGAN WV OFFICE
CH4045222Medicare ID - Type UnspecifiedCHARLESTON WV OFFICE
CH4045225Medicare ID - Type UnspecifiedRIPLEY WV OFFICE