Provider Demographics
NPI:1326022674
Name:CHANG MOSES, KARI JEANE YUKO (OD)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:JEANE YUKO
Last Name:CHANG MOSES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KARI
Other - Middle Name:JEANNE YUKO
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3768
Mailing Address - Country:US
Mailing Address - Phone:808-235-6641
Mailing Address - Fax:808-247-3880
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3768
Practice Address - Country:US
Practice Address - Phone:808-235-6641
Practice Address - Fax:808-247-3880
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI547309Medicaid
HI0824380001OtherCIGNA SUPPLIER #
HIBY562AMedicare PIN
HI547309Medicaid
HIBY562BMedicare PIN
U88135Medicare UPIN
HIBY565YMedicare PIN