Provider Demographics
NPI:1336108851
Name:AN, HYUNG W (MD)
Entity Type:Individual
Prefix:
First Name:HYUNG
Middle Name:W
Last Name:AN
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:PO BOX 4033
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-4033
Mailing Address - Country:US
Mailing Address - Phone:530-872-8684
Mailing Address - Fax:530-872-8495
Practice Address - Street 1:6161 CLARK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4164
Practice Address - Country:US
Practice Address - Phone:530-872-8684
Practice Address - Fax:530-872-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA383688642OtherBLUE CROSS
CA00A647260Medicaid
CA00A647260OtherBLUE SHIELD
CA383688642OtherTRICARE
CA5492774OtherFIRST HEALTH-CCN
CA383688642OtherTRICARE
CA383688642OtherBLUE CROSS