Provider Demographics
NPI:1518058254
Name:CHIN, BYOUNG-KWON (MD)
Entity Type:Individual
Prefix:DR
First Name:BYOUNG-KWON
Middle Name:
Last Name:CHIN
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 1:763 GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3438
Mailing Address - Country:US
Mailing Address - Phone:215-357-0733
Mailing Address - Fax:215-357-1434
Practice Address - Street 1:763 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3438
Practice Address - Country:US
Practice Address - Phone:215-357-0733
Practice Address - Fax:215-357-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033805L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007577720001Medicaid
PA154477Medicare ID - Type UnspecifiedMEDICARE ID
PA0007577720001Medicaid