1164499240 NPI number — SU MIN CHANG MD

Table of content: SU MIN CHANG MD (NPI 1164499240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164499240 NPI number — SU MIN CHANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
SU
Provider Middle Name:
MIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1164499240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 1901
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-1100
Provider Business Mailing Address Fax Number:
713-790-2643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 1901
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-1100
Provider Business Practice Location Address Fax Number:
713-790-2643
Provider Enumeration Date:
03/07/2006

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: 207RC0000X , with the licence number:  45434 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: K9499 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01309509 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 190639807 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01037115 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 190639802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190639803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190639801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190639806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8AH671 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 34365500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1886602 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00459994 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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