Provider Demographics
NPI:1194833079
Name:CHANG, YONG D (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:D
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 1:2324 OLD DENTON RD 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1440
Mailing Address - Country:US
Mailing Address - Phone:972-245-0028
Mailing Address - Fax:972-245-0029
Practice Address - Street 1:2324 OLD DENTON RD STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1440
Practice Address - Country:US
Practice Address - Phone:972-245-0028
Practice Address - Fax:972-245-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035081104Medicaid
1225440092OtherNPI
TX035081102Medicaid
TX035081106Medicaid
TX035081105Medicaid
TX8J0048Medicare ID - Type Unspecified
TX035081105Medicaid
TX8J2326Medicare ID - Type Unspecified
TX035081104Medicaid