Provider Demographics
NPI:1114938578
Name:CHOI, CHANGHYUN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHANGHYUN
Middle Name:MICHAEL
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:MICHAEL
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3495 HACKS CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8803
Mailing Address - Country:US
Mailing Address - Phone:901-526-7444
Mailing Address - Fax:901-271-2618
Practice Address - Street 1:3495 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8803
Practice Address - Country:US
Practice Address - Phone:901-526-7444
Practice Address - Fax:901-271-2618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41778207ZC0500X, 207ZP0102X
OH35-050962C207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000135404OtherANTHEM BC/BS
OH0893510Medicaid
OH341632753029OtherCARESOURCE
OH341632753POtherSUMMACARE
OH341632753OtherAULTCARE
OH89601OtherQUALCHOICE
OH341632753002OtherMEDICAL MUTUAL
OH341632753002OtherMEDICAL MUTUAL
OH341632753002OtherMEDICAL MUTUAL