Provider Demographics
NPI:1831937556
Name:AN, BYOUNGCHAN
Entity type:Individual
Prefix:
First Name:BYOUNGCHAN
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 W ILLINOIS ST
Mailing Address - Street 2:APT 205
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710
Mailing Address - Country:US
Mailing Address - Phone:260-431-7247
Mailing Address - Fax:
Practice Address - Street 1:25 W ILLINOIS ST
Practice Address - Street 2:APT 205
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710
Practice Address - Country:US
Practice Address - Phone:260-431-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program