Healthcare Provider Details

I. General information

NPI: 1083612139
Provider Name (Legal Business Name): SUNG OOK WHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 N WAYNE ST
ANGOLA IN
46703-2348
US

IV. Provider business mailing address

1381 N WAYNE ST
ANGOLA IN
46703-2348
US

V. Phone/Fax

Practice location:
  • Phone: 260-667-5613
  • Fax: 260-667-5630
Mailing address:
  • Phone: 260-667-5624
  • Fax: 260-665-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01034452A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01034452
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: