Provider Demographics
NPI:1205073053
Name:CHOI, HYON JUNG (PA)
Entity type:Individual
Prefix:
First Name:HYON
Middle Name:JUNG
Last Name:CHOI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 S BUCKNER BLVD
Mailing Address - Street 2:STE. 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6945
Mailing Address - Country:US
Mailing Address - Phone:214-206-4974
Mailing Address - Fax:214-206-4979
Practice Address - Street 1:2623 MATLOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2509
Practice Address - Country:US
Practice Address - Phone:817-276-6850
Practice Address - Fax:817-861-3023
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00695496OtherRAILROAD MEDICARE
TX199617501Medicaid
TX199617501Medicaid
TXTXB102348Medicare PIN
TXP00695496OtherRAILROAD MEDICARE
TX8L8077Medicare PIN