Healthcare Provider Details

I. General information

NPI: 1265636179
Provider Name (Legal Business Name): SUZIE HEEJEONG CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23920 KATY FWY STE 405
KATY TX
77494
US

IV. Provider business mailing address

23920 KATY FWY STE 405
KATY TX
77494-0805
US

V. Phone/Fax

Practice location:
  • Phone: 281-369-5490
  • Fax: 281-369-5476
Mailing address:
  • Phone: 281-369-5490
  • Fax: 281-369-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberN9184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: