1073516027 NPI number — DR. JOHN CHU-HONG CHANG M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	CHANG
Provider First Name	:	JOHN
Provider Middle Name	:	CHU-HONG
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1073516027
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	10/06/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	169 N MIDDLETOWN RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	PEARL RIVER
Provider Business Mailing Address State Name	:	NY
Provider Business Mailing Address Postal Code	:	109652029
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8457355666
Provider Business Mailing Address Fax Number	:	8457355673

Provider First Line Business Practice Location Address	:	169 N MIDDLETOWN RD
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	PEARL RIVER
Provider Business Practice Location Address State Name	:	NY
Provider Business Practice Location Address Postal Code	:	109652029
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	8457355666
Provider Business Practice Location Address Fax Number	:	8457355673
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 174400000X , with the licence number:  225687-1 , registered in the state of NY .

• Identifier: 02362274 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: H76950 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: WEX951 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: 132998987 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: 429B41 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: P00014839 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: P00014839 , issued by the state of ( NY ) . This identifiers is of the category "".