Basic Information
| Provider Information | |||||||||
| NPI: | 1598721342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200903 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772160903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 MOURSUND ST | ||||||||
| Address2: | E-105 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137995071 | ||||||||
| FaxNumber: | 7137995095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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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 | 208100000X | P4741 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | TX | MEDICAID |