Provider Demographics
NPI:1831256072
Name:CHANG, HEERA (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:HEERA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 HAHANI ST
Mailing Address - Street 2:# 1635
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-7400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 LANAKILA AVE
Practice Address - Street 2:203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2115
Practice Address - Country:US
Practice Address - Phone:808-832-5710
Practice Address - Fax:808-832-5674
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17632204E00000X
HICSDT-801223S0112X
MADN18552891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery