Provider Demographics
NPI:1134382500
Name:CHANG, WILFRED ASHLEY JR (LMT)
Entity type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:ASHLEY
Last Name:CHANG
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 AANIU LOOP
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1310
Mailing Address - Country:US
Mailing Address - Phone:808-306-1358
Mailing Address - Fax:
Practice Address - Street 1:2020 AANIU LOOP
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1310
Practice Address - Country:US
Practice Address - Phone:808-306-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT- 6194171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor