Provider Demographics
NPI:1134215551
Name:CHANG, JOCELYN U (DO)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:U
Last Name:CHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-7204
Practice Address - Street 1:53-3925 AKONI PULE HWY
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-6236
Practice Address - Fax:808-889-0107
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS769207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI079683-04Medicaid
HIDOS-769OtherSTATE LICENSE
HIE02636OtherCONTROLLED SUBSTANCES
HIBC4707177OtherDEA
HIH0000LCBSNMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
HI079683-04Medicaid