Provider Demographics
NPI:1306880471
Name:CHANG, HYUN SIK (MD)
Entity type:Individual
Prefix:DR
First Name:HYUN
Middle Name:SIK
Last Name:CHANG
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 1:3815 PELHAM, SUITE 5
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3852
Mailing Address - Country:US
Mailing Address - Phone:313-565-6999
Mailing Address - Fax:
Practice Address - Street 1:3815 PELHAM, SUITE 5
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-565-6999
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHC035471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI125189OtherCARE CHOICE
MI0821008OtherBCBSM
MI0208210081OtherBLUE CARE NETWORK
MIA77116OtherHEALTH ALLIANCE PLAN
MI100000006598OtherMEDICARE PLUS BLUE
MI2713276Medicaid
MI306338OtherCIGNA
MI0208210081OtherBLUE CROSS BLUE SHIELD
MIB6031OtherMCARE
MI000000001968OtherCAPE HEALTH
MI5441259OtherAETNA
MI78977OtherPHCS
MI100000006598OtherMEDICARE PLUS BLUE
MIA77116Medicare UPIN