Provider Demographics
NPI:1356371124
Name:CHANG, CHI HO (MD)
Entity type:Individual
Prefix:MR
First Name:CHI
Middle Name:HO
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 1:102 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2504
Mailing Address - Country:US
Mailing Address - Phone:914-668-5353
Mailing Address - Fax:914-668-3770
Practice Address - Street 1:102 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2504
Practice Address - Country:US
Practice Address - Phone:914-668-5353
Practice Address - Fax:914-668-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA124375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD38933Medicare UPIN
NY07D211Medicare ID - Type Unspecified