Provider Demographics
NPI:1528161932
Name:CHOUNG, SOUNG W (MD)
Entity type:Individual
Prefix:
First Name:SOUNG
Middle Name:W
Last Name:CHOUNG
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 1:8793 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-717-9779
Mailing Address - Fax:440-815-2023
Practice Address - Street 1:6688 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129
Practice Address - Country:US
Practice Address - Phone:440-717-9779
Practice Address - Fax:440-815-2023
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0525097Medicaid
C02487Medicare UPIN
OH0525097Medicaid