Basic Information
Provider Information
NPI: 1588861280
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANG
FirstName: LEE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1914 RIDGEWOOD ST APT C
Address2:  
City: HOUSTON
State: TX
PostalCode: 770061965
CountryCode: US
TelephoneNumber: 7132406949
FaxNumber:  
Practice Location
Address1: 1504 TAUB LOOP
Address2:  
City: HOUSTON
State: TX
PostalCode: 770301608
CountryCode: US
TelephoneNumber: 7137987356
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2007
LastUpdateDate: 09/29/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XM6075TXY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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