Provider Demographics
NPI:1619990397
Name:CHOUNG, LISA L (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:CHOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:WHITE-CHOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:955 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3376
Mailing Address - Country:US
Mailing Address - Phone:614-268-9561
Mailing Address - Fax:614-268-7849
Practice Address - Street 1:955 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3376
Practice Address - Country:US
Practice Address - Phone:614-268-9561
Practice Address - Fax:614-268-7849
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350882832081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000483238OtherANTHEM PIN
OH2668662Medicaid
WH4185371Medicare ID - Type Unspecified
OH2668662Medicaid