Provider Demographics
NPI:1417996109
Name:CHANG, CHARLIE CHIH LEE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:CHIH LEE
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:PO BOX 57336
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7336
Mailing Address - Country:US
Mailing Address - Phone:281-724-8333
Mailing Address - Fax:281-336-1680
Practice Address - Street 1:600 N KOBAYASHI STE 312
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8333
Practice Address - Fax:281-336-1680
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6318207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180519402Medicaid
TX180519403Medicaid
TX8DU593OtherBCBSTX
TX296871YLMGMedicare PIN