Provider Demographics
NPI:1144766486
Name:HONU SMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:HONU SMILES PEDIATRIC DENTISTRY
Other - Org Name:JOHN WILLIAM K.M.CHANG,D.D.S, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-221-2367
Mailing Address - Street 1:95-1105 AINAMAKUA DR
Mailing Address - Street 2:#202
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95-1105 AINAMAKUA DR
Practice Address - Street 2:#202
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-6313
Practice Address - Country:US
Practice Address - Phone:206-291-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-25431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty