Provider Demographics
NPI:1679581458
Name:CHANG, HO-CHOONG (MD)
Entity Type:Individual
Prefix:
First Name:HO-CHOONG
Middle Name:
Last Name:CHANG
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 1:76 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3305
Mailing Address - Country:US
Mailing Address - Phone:860-547-0970
Mailing Address - Fax:860-547-0980
Practice Address - Street 1:76 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3305
Practice Address - Country:US
Practice Address - Phone:860-547-0970
Practice Address - Fax:860-547-0980
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0681761208000000X
NJ25MA06940000208000000X
CT62224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001763774Medicaid
H03222Medicare UPIN