MARK WAN SOO CHANG (NPI# 1174632475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174632475 |
| Entity Type | Individual |
| Full Name | MARK WAN SOO CHANG |
| Credential | MD |
| Practice Address |
2428 Knob Creek Road Johnson City TN 37604 |
| Mailing Address |
105 W Stone Dr Suite 6a Kingsport TN 37660-3365 |
| Practice Telephone | 4232825054 |
| Practice Fax Number | 4232305097 |
| Mailing Telephone | 4234087220 |
| Mailing Fax Number | 4234087405 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-12-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
0101059203 | VA | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
28931 | TN | Allopathic & Osteopathic Physicians |
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
0101059203 | VA | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
28931 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MEDICAID OF VA | 005867967 | 01 |
| TN | 3373123 | 05 | |
| TN | BCBS | 4017298 | 01 |
| TN | JDH | TN0102 | 01 |
| VA | ANTHEM | 320332 | 01 |
| KY | 64001084 | 05 | |
| NC | 790596V | 05 | |
| NC | 89014AT | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679926679 | Mark Chang | Counselor | 1738 N Jupiter Rd, 1104, Garland, TX 75042-8699 | 2016-07-14 |
| 1356564934 | Mark Chang | Urology | 2 Medical Park Dr., West Nyac, NY 10994 | 2007-04-11 |
| 1861954182 | Mark Joshua Chang | Student in an Organized Health Care Education/Training Program | 1800 W Charleston Blvd, Las Vegas, NV 89102-2329 | 2019-04-04 |
| 1689974107 | Mark Nicholas Chang | Pharmacist | 2214 El Camino Ave, Sacramento, CA 95821-4602 | 2010-11-01 |
| 1164500815 | Mark B. Chang | Internal Medicine | 2025 Morse Ave, Sacramento, CA 95825-2115 | 2006-11-01 |
| 1871607507 | Mark K Chang | Orthopaedic Surgery | 1100 Joliet St, Ste 104, Dyer, IN 46311-1996 | 2006-08-19 |
| Street Address |
2428 KNOB CREEK ROAD |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568572402 | Scott David Jay | Internal Medicine | 2428 Knob Creek Road, Johnson City, TN 37604 | 2006-08-30 |
| 1083706113 | Joseph C Bailey | Internal Medicine | 2428 Knob Creek Road, Suite 201, Johnson City, TN 37604 | 2006-09-28 |
| 1710096938 | Harold Wayne Alison | Specialist | 2428 Knob Creek Road, Johnson City, TN 37604 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972145456 | Cardiovascular & Vein Associates Pllc | Internal Medicine | 2785 Summer Oaks Dr, Bartlett, TN 38134-2883 | 2019-10-16 |
| 1063910529 | James Joseph Acker I | Internal Medicine | 205 Todaly Cir, Loudon, TN 37774-2990 | 2018-01-30 |
| 1215445192 | Cardiac Cin of Middle Tennessee LLC | Internal Medicine | 315 Deaderick St Ste 1550c, Nashville, TN 37238-3000 | 2018-01-13 |
| 1588172464 | Cardiac Cin of West Tennessee LLC | Internal Medicine | 5865 Ridgeway Center Pkwy Ste 300c, Memphis, TN 38120-4032 | 2018-01-13 |
| 1922520873 | Telemedico Physicians Professional Corporation | Internal Medicine | 5490 Shady Grove Ter, Memphis, TN 38120-2414 | 2017-07-12 |
| 1114455326 | Nashville Heart and Vascular | Internal Medicine | 397 Wallace Rd Ste C216, Nashville, TN 37211-8019 | 2017-06-01 |
| 1942631387 | Cvc Imaging LLC | Internal Medicine | 9203 Sheridan Park Ct, Brentwood, TN 37027-1748 | 2013-12-11 |
| 1730460718 | Ronald Craig Sebold | Internal Medicine | 7450 Chapman Hwy, #309, Knoxville, TN 37920-6614 | 2011-09-02 |
| 1467494070 | Apex Cardiology PC | Internal Medicine | 327 Summar Dr, Jackson, TN 38301-3930 | 2006-06-11 |
| 1700823960 | Thomas Little | Internal Medicine | 228 W. 4th Street, Suite 200, Cookeville, TN 38501 | 2006-05-31 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.