Provider Demographics
NPI:1366653651
Name:CHANG, HING DAT SUM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HING
Middle Name:DAT SUM
Last Name:CHANG
Suffix:JR
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 1:1314 S KING STREET
Mailing Address - Street 2:SUITE 419
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1939
Mailing Address - Country:US
Mailing Address - Phone:808-593-8855
Mailing Address - Fax:808-591-8340
Practice Address - Street 1:1314 S KING STREET
Practice Address - Street 2:SUITE 419
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1939
Practice Address - Country:US
Practice Address - Phone:808-593-8855
Practice Address - Fax:808-591-8340
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT06741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06587801Medicaid