Basic Information
Provider Information
NPI: 1831370535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANG
FirstName: TERENCE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16107 KENSINGTON DR STE 126
Address2:  
City: SUGAR LAND
State: TX
PostalCode: 774794224
CountryCode: US
TelephoneNumber: 2817395304
FaxNumber:  
Practice Location
Address1: 5749 SAN FELIPE ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 770573101
CountryCode: US
TelephoneNumber: 2817838162
FaxNumber: 7134397995
Other Information
ProviderEnumerationDate: 11/21/2007
LastUpdateDate: 04/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QS0010XM7098TXN Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
207Q00000XM7098TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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