Individual
MARK WAN SOO CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2428 KNOB CREEK ROAD, JOHNSON CITY, TN 37604
(423) 282-5054
(423) 230-5097
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101059203
VA
207RC0000X
Cardiovascular Disease Physician
28931
TN
207RI0011X
Interventional Cardiology Physician
0101059203
VA
207RI0011X
Interventional Cardiology Physician
Primary
28931
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005867967
MEDICAID OF VA
VA
01
—
320332
ANTHEM
VA
05
—
3373123
—
TN
01
—
4017298
BCBS
TN
05
—
64001084
—
KY
05
—
790596V
—
NC
05
—
89014AT
—
NC
01
—
TN0102
JDH
TN
Enumeration date
08/30/2006
Last updated
12/03/2014
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