Provider Demographics
NPI:1497796379
Name:CHO, SUNG-RAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG-RAN
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUNG-RAN
Other - Middle Name:CHO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:#305
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5360
Mailing Address - Country:US
Mailing Address - Phone:248-552-8110
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-372-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010321292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260638180OtherBCBS OF MI
MI1069930Medicaid
MI260638180OtherBCBS OF MI
MI0638180Medicare PIN