Provider Demographics
NPI:1437720265
Name:CHANG, SHIH MIN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:SHIH MIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 SAND RIDGE XING
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5636
Mailing Address - Country:US
Mailing Address - Phone:310-890-8869
Mailing Address - Fax:
Practice Address - Street 1:14023 SAND RIDGE XING
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-5636
Practice Address - Country:US
Practice Address - Phone:310-890-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83682133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal