Basic Information
| Provider Information | |||||||||
| NPI: | 1205073053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOI | ||||||||
| FirstName: | HYON | ||||||||
| MiddleName: | JUNG | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2959 S BUCKNER BLVD | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752276945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142064974 | ||||||||
| FaxNumber: | 2142064979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2623 MATLOCK RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760152509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172766850 | ||||||||
| FaxNumber: | 8178613023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2009 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA06006 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P00695496 | 01 | TX | RAILROAD MEDICARE | OTHER | 199617501 | 05 | TX | MEDICAID |