Basic Information
| Provider Information | |||||||||
| NPI: | 1164499240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | SU | ||||||||
| MiddleName: | MIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | 7137902643 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SUITE 1901 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134411100 | ||||||||
| FaxNumber: | 7137902643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 45434 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | K9499 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P01309509 | 01 | TX | RR MEDICARE | OTHER | 190639807 | 05 | TX | MEDICAID | P01037115 | 01 | TX | RR MEDICARE | OTHER | 190639802 | 05 | TX | MEDICAID | 190639803 | 05 | TX | MEDICAID | 190639801 | 05 | TX | MEDICAID | 190639806 | 05 | TX | MEDICAID | 8AH671 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 34365500 | 05 | WI | MEDICAID | 1886602 | 05 | LA | MEDICAID | P00459994 | 01 | TX | RAILROAD MEDICARE | OTHER |