Provider Demographics
NPI:1285698738
Name:CHANG, SUNG KYU (MD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:KYU
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7351 OLD MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7291
Mailing Address - Country:US
Mailing Address - Phone:706-653-7000
Mailing Address - Fax:704-377-3389
Practice Address - Street 1:7351 OLD MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7291
Practice Address - Country:US
Practice Address - Phone:706-653-7000
Practice Address - Fax:706-653-7800
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52693207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA141512294AMedicaid
GA511I090013OtherMEDICARE PTAN
GA52261875-001OtherBCBSGA
GA511I090013OtherMEDICARE PTAN