1083877740 NPI number — DR. EMMANUEL YIH-HERNG CHANG MD/PHD

Table of content: DR. EMMANUEL YIH-HERNG CHANG MD/PHD (NPI 1083877740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083877740 NPI number — DR. EMMANUEL YIH-HERNG CHANG MD/PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
EMMANUEL
Provider Middle Name:
YIH-HERNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD/PHD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1083877740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 GRAMERCY ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77025-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-799-9975
Provider Business Mailing Address Fax Number:
713-799-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 GRAMERCY ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77025-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-799-9975
Provider Business Practice Location Address Fax Number:
713-799-1095
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  P5786 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X , with the licence number: P5786 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 322767004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322767002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083877740 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322767003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322767005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083877740 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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