Provider Demographics
NPI:1558676031
Name:CHANG, KYLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KALAKAUA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3756
Mailing Address - Country:US
Mailing Address - Phone:808-779-0626
Mailing Address - Fax:
Practice Address - Street 1:1750 KALAKAUA AVE STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3756
Practice Address - Country:US
Practice Address - Phone:808-779-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical