Provider Demographics
NPI:1679581458
Name:CHANG, HO-CHOONG (MD)
Entity type:Individual
Prefix:
First Name:HO-CHOONG
Middle Name:
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 1:150 SARGENT DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6100
Mailing Address - Country:US
Mailing Address - Phone:203-777-7411
Mailing Address - Fax:
Practice Address - Street 1:150 SARGENT DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6100
Practice Address - Country:US
Practice Address - Phone:203-777-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0681761208000000X
NJ25MA06940000208000000X
CT62224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001763774Medicaid
H03222Medicare UPIN