Provider Demographics
NPI:1629204409
Name:CHOONG, HAN PYO (MD)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:PYO
Last Name:CHOONG
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 1:232 NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-2194
Mailing Address - Country:US
Mailing Address - Phone:828-632-7171
Mailing Address - Fax:
Practice Address - Street 1:4925 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1544
Practice Address - Country:US
Practice Address - Phone:336-235-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922459Medicaid
NCD83395Medicare UPIN
NC201414Medicare PIN