Provider Demographics
NPI:1083650725
Name:CHANG, RODNEY EJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:EJ
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 N KING ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4550
Mailing Address - Country:US
Mailing Address - Phone:808-845-6216
Mailing Address - Fax:808-841-6872
Practice Address - Street 1:2119 N KING ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4550
Practice Address - Country:US
Practice Address - Phone:808-845-6216
Practice Address - Fax:808-841-6872
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08762-7OtherPROVIDER ID #
HI067220-01Medicaid
HI89301OtherPROVIDER ID #
HI893OtherLICENSE #