Provider Demographics
NPI:1366641573
Name:YI, CHONG U (MD)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:U
Last Name:YI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2030 LOCHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3919
Mailing Address - Country:US
Mailing Address - Phone:248-937-0212
Mailing Address - Fax:248-366-4510
Practice Address - Street 1:2030 LOCHAVEN RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3919
Practice Address - Country:US
Practice Address - Phone:248-937-0212
Practice Address - Fax:248-366-4510
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084543207Q00000X
OH35.090527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2797951Medicaid
MI1174841100Medicaid
MIMI3608001Medicare PIN
MI1174841100Medicaid