Provider Demographics
NPI:1881217586
Name:CHANG, KAPONO (DO)
Entity Type:Individual
Prefix:DR
First Name:KAPONO
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1005 MOANALUA RD
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4777
Mailing Address - Country:US
Mailing Address - Phone:808-627-3200
Mailing Address - Fax:808-623-7872
Practice Address - Street 1:98-1005 MOANALUA RD SPC 3030
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4735
Practice Address - Country:US
Practice Address - Phone:808-627-3200
Practice Address - Fax:808-623-7872
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOSR-502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine