Provider Demographics
NPI:1235259078
Name:CHANG, JEANETTE HUNG JOW (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:HUNG JOW
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 SO KING ST
Mailing Address - Street 2:STE #414
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-593-8686
Mailing Address - Fax:808-597-1288
Practice Address - Street 1:1314 SO KING ST
Practice Address - Street 2:STE 414
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-593-8686
Practice Address - Fax:808-597-1288
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36293Medicare UPIN