Provider Demographics
NPI:1265636179
Name:CHANG, SUZIE HEEJEONG (MD)
Entity Type:Individual
Prefix:
First Name:SUZIE
Middle Name:HEEJEONG
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23920 KATY FWY STE 405
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0805
Mailing Address - Country:US
Mailing Address - Phone:281-369-5490
Mailing Address - Fax:281-369-5476
Practice Address - Street 1:23920 KATY FWY STE 405
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-369-5490
Practice Address - Fax:281-369-5476
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN91842086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026520OtherINSTITUTIONAL PERMIT