Provider Demographics
NPI:1265723266
Name:CHOO, ALEXANDER DAEKYUNG (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAEKYUNG
Last Name:CHOO
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 1:8501 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2046
Mailing Address - Country:US
Mailing Address - Phone:317-875-9105
Mailing Address - Fax:317-872-6873
Practice Address - Street 1:33 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6007
Practice Address - Country:US
Practice Address - Phone:203-792-5558
Practice Address - Fax:203-731-3213
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076555A207X00000X
CT56936207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201363410Medicaid
IN062110051Medicare PIN