Provider Demographics
NPI:1659412773
Name:CHANG, CARY KEALIIOLANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:KEALIIOLANI
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 1:46-001 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 318
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3711
Mailing Address - Country:US
Mailing Address - Phone:808-236-1336
Mailing Address - Fax:808-234-0176
Practice Address - Street 1:46-001 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 318
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3711
Practice Address - Country:US
Practice Address - Phone:808-236-1336
Practice Address - Fax:808-234-0176
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice