Provider Demographics
NPI:1184797847
Name:CHANG, SHAO-JEN (MD)
Entity type:Individual
Prefix:
First Name:SHAO-JEN
Middle Name:
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 1:123 MEDICAL PARK LN STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4981
Mailing Address - Country:US
Mailing Address - Phone:936-291-2116
Mailing Address - Fax:936-435-7824
Practice Address - Street 1:123 MEDICAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4981
Practice Address - Country:US
Practice Address - Phone:936-291-2116
Practice Address - Fax:936-435-7824
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3891207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG96908Medicare UPIN
TXTXB142238Medicare PIN