Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | N9184 | TX |
NPI | 1265636179 |
---|---|
Provider Name | Suzie Heejeong Chang |
First Address | Katy, TX 77494-0805 |
Second Address | Katy, TX 77494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 29/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP1-0026520 | INSTITUTIONAL PERMIT (01) |