Provider Demographics
NPI:1538291026
Name:CHANG, HUBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:
Last Name:CHANG
Suffix:
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 1:1507 S KING ST
Mailing Address - Street 2:#204
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1930
Mailing Address - Country:US
Mailing Address - Phone:808-944-3000
Mailing Address - Fax:808-946-6989
Practice Address - Street 1:1507 S KING ST
Practice Address - Street 2:#204
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1930
Practice Address - Country:US
Practice Address - Phone:808-944-3000
Practice Address - Fax:808-946-6989
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-16921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07076201Medicaid