Provider Demographics
NPI:1265816029
Name:CHANG, LAURA JUJIN (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JUJIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1934
Mailing Address - Country:US
Mailing Address - Phone:206-291-8879
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 111
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5300
Practice Address - Country:US
Practice Address - Phone:808-732-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist