Provider Demographics
NPI:1437234598
Name:LAI, CHANG D (MD)
Entity Type:Individual
Prefix:MR
First Name:CHANG
Middle Name:D
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:1015
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2461
Mailing Address - Country:US
Mailing Address - Phone:808-537-6761
Mailing Address - Fax:808-536-6740
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:1015
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2461
Practice Address - Country:US
Practice Address - Phone:808-537-6761
Practice Address - Fax:808-536-6740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD6970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06459101Medicaid
E79298Medicare UPIN
HI06459101Medicaid