Provider Demographics
NPI:1972829893
Name:JOH, WILLIAM KYUNGHA
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KYUNGHA
Last Name:JOH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KYUNGHA
Other - Middle Name:
Other - Last Name:JOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5605 PEMBROOKE XING
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1794
Mailing Address - Country:US
Mailing Address - Phone:248-505-1783
Mailing Address - Fax:313-456-1579
Practice Address - Street 1:3028 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-6028
Practice Address - Country:US
Practice Address - Phone:313-456-1553
Practice Address - Fax:313-456-1579
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine