Provider Demographics
NPI:1467412593
Name:BAHNG, CHANG HWAN (MD)
Entity Type:Individual
Prefix:
First Name:CHANG
Middle Name:HWAN
Last Name:BAHNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHANG
Other - Middle Name:HWAN
Other - Last Name:BANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5128
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-5128
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:419-229-0040
Practice Address - Street 1:915 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-2311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0410232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443587Medicaid
OHP00081568OtherRAILROAD MEDICARE
OH000000317647OtherANTHEM BCBS
OH0443587Medicaid
OHBA0492513Medicare ID - Type Unspecified