Provider Demographics
NPI:1083612139
Name:WHANG, SUNG OOK (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:OOK
Last Name:WHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2348
Mailing Address - Country:US
Mailing Address - Phone:260-667-5624
Mailing Address - Fax:260-665-5630
Practice Address - Street 1:1381 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2348
Practice Address - Country:US
Practice Address - Phone:260-667-5613
Practice Address - Fax:260-667-5630
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034452208600000X
IN01034452A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100225640Medicaid
INB29446Medicare UPIN
INM400033998Medicare PIN
IN770890AMedicare PIN