Provider Demographics
NPI:1164499240
Name:CHANG, SU MIN (MD)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:MIN
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1901
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1901
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45434207RC0000X
TXK9499207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01309509OtherRR MEDICARE
TX190639807Medicaid
TXP01037115OtherRR MEDICARE
TX190639802Medicaid
TX190639803Medicaid
TX190639801Medicaid
TX190639806Medicaid
TX8AH671OtherBLUE CROSS BLUE SHIELD
WI34365500Medicaid
LA1886602Medicaid
TXP00459994OtherRAILROAD MEDICARE
WI34365500Medicaid
NE$$$$$$$$$Medicaid
TXTXB145671Medicare PIN
TX8AH671OtherBLUE CROSS BLUE SHIELD
TX8F8584Medicare PIN
TXP01037115OtherRR MEDICARE
TX338625YMVQMedicare PIN
TX8K2428Medicare PIN