Provider Demographics
NPI:1346237872
Name:CHANG, MICHAEL YUSHUN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YUSHUN
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 COLLEGE PARK DR STE 107
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4001
Mailing Address - Country:US
Mailing Address - Phone:936-321-6787
Mailing Address - Fax:936-321-6802
Practice Address - Street 1:3115 COLLEGE PARK DR STE 107
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-321-6787
Practice Address - Fax:936-321-6802
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165452702Medicaid
TXH43152Medicare UPIN
TX165452702Medicaid