Provider Demographics
NPI:1467451575
Name:CHANG, YUPO JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:YUPO
Middle Name:JESSE
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 1:3711 BRIARPARK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-5246
Mailing Address - Country:US
Mailing Address - Phone:713-893-3792
Mailing Address - Fax:
Practice Address - Street 1:3711 BRIARPARK DR STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-5246
Practice Address - Country:US
Practice Address - Phone:713-893-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6075Medicare PIN
TXG97836Medicare UPIN