Provider Demographics
NPI:1497788509
Name:CHA, HYUN SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:SUSAN
Last Name:CHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUTTON PL APT 21B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2429
Mailing Address - Country:US
Mailing Address - Phone:917-434-3022
Mailing Address - Fax:
Practice Address - Street 1:2315 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4332
Practice Address - Country:US
Practice Address - Phone:646-962-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6B5881OtherEMPIRE BLUE CROSS BLUE SH
NY02594205Medicaid
NYI19661Medicare UPIN
NY6B5881OtherEMPIRE BLUE CROSS BLUE SH