Provider Demographics
NPI:1558767657
Name:CHEN, CHANG-HAN T (PT)
Entity Type:Individual
Prefix:MR
First Name:CHANG-HAN
Middle Name:T
Last Name:CHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0565
Mailing Address - Country:US
Mailing Address - Phone:808-652-8268
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1855
Practice Address - Country:US
Practice Address - Phone:808-377-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist