MEDICARE: CHANG HYUN MIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	1105301	NY

General Provider Information

NPI Number	:	1336248541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANG HYUN MIN MD

Provider Business Mailing Address
First Line	:	132 DOCK RD
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2905
Country	:	US
Telephone Number	:	631-277-4959
Fax Number	:	631-277-4959

Provider Business Practice Location Address
First Line	:	132 DOCK RD
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2905
Country	:	US
Telephone Number	:	631-277-4959
Fax Number	:	631-277-4959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/17/2007

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