Provider Demographics
NPI:1104823301
Name:CHANG, HYUNSOO JEWEL (MD)
Entity Type:Individual
Prefix:
First Name:HYUNSOO
Middle Name:JEWEL
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BUCKEYE RD
Mailing Address - Street 2:SUITE178
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4229
Mailing Address - Country:US
Mailing Address - Phone:770-458-6103
Mailing Address - Fax:770-234-0437
Practice Address - Street 1:3300 BUCKEYE RD
Practice Address - Street 2:SUITE178
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4229
Practice Address - Country:US
Practice Address - Phone:770-458-6103
Practice Address - Fax:770-234-0437
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040634207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH28129Medicare UPIN