Provider Demographics
NPI:1821566670
Name:CHANG, HAO-MIN
Entity Type:Individual
Prefix:
First Name:HAO-MIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 MAIN ST STE 202A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5164
Mailing Address - Country:US
Mailing Address - Phone:718-886-3288
Mailing Address - Fax:
Practice Address - Street 1:4199 MAIN ST STE 202A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5164
Practice Address - Country:US
Practice Address - Phone:718-886-3288
Practice Address - Fax:718-886-3988
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist