Provider Demographics
NPI:1073833075
Name:CHAE, PHILLIP HYUNSUK (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HYUNSUK
Last Name:CHAE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY STE 100
Practice Address - Street 2:CRADDICK MEDICAL OFFICE BLDG.
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5849
Practice Address - Country:US
Practice Address - Phone:432-687-1949
Practice Address - Fax:432-687-4251
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8851207R00000X, 207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01830998OtherRAILROAD
TX360214601Medicaid
TX360214601Medicaid