Provider Demographics
NPI:1770592990
Name:CHOI, KWANG H (PSYD)
Entity type:Individual
Prefix:
First Name:KWANG
Middle Name:H
Last Name:CHOI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 LINCOLNWAY LN STE 207A
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1908
Mailing Address - Country:US
Mailing Address - Phone:815-277-7012
Mailing Address - Fax:844-859-1447
Practice Address - Street 1:9645 LINCOLNWAY LN STE 207A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1908
Practice Address - Country:US
Practice Address - Phone:815-277-7012
Practice Address - Fax:844-859-1447
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041982A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000361964OtherANTHEM BCBS
IN200542420Medicaid
IN800579000OtherMAGELLAN
IN90001228OtherBCBSIL
INN7997725OtherAETNA