Provider Demographics
NPI:1396848305
Name:CHA, PAUL SANGYONG (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SANGYONG
Last Name:CHA
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 1:781 WEATHERLY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8953
Mailing Address - Country:US
Mailing Address - Phone:931-647-7200
Mailing Address - Fax:931-645-1546
Practice Address - Street 1:781 WEATHERLY DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8953
Practice Address - Country:US
Practice Address - Phone:931-647-7200
Practice Address - Fax:931-645-1546
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016287207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN46902OtherBCBS
621242488OtherCIGNA AND ALL OTHER COMME
KY64778756OtherKY MEDICAID
TN3015201Medicaid
2646213OtherAETNA
KY64778756OtherKY MEDICAID
2646213OtherAETNA