Chang, Mark Wan Soo

Chang, Mark Wan Soo is an individual health care provider with primary practice located at 2428 Knob Creek Road , Johnson City TN 37604. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Chang, Mark Wan Soo can be contacted via phone (423) 282-5054.

Contact Information

Primary practice address
2428 Knob Creek Road Johnson City TN 37604
Phone: (423) 282-5054
Fax: (423) 230-5097
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 28931 Tennessee
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 0101059203 Virginia
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 28931 Tennessee
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 0101059203 Virginia

Profile Details

NPI number 1174632475
LBN Legal business name Chang, Mark Wan Soo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2006
Last updated Dec 3rd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174632475 NPPES
North Carolina MEDICAID 790596V
North Carolina MEDICAID 89014AT
North Carolina Other 005867967
North Carolina MEDICAID 3373123
North Carolina Other TN0102
North Carolina Other 320332
North Carolina Other 4017298
North Carolina MEDICAID 64001084

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