Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DOS769 | HI |
NPI | 1134215551 |
---|---|
Provider Name | Dr. Jocelyn U Chang |
First Address | Honokaa, HI 96727-6902 |
Second Address | Kapaau, HI 96755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 31/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079683-04 | (05) | HI |
BC4707177 | DEA (01) | HI |
DOS-769 | STATE LICENSE (01) | HI |
E02636 | CONTROLLED SUBSTANCES (01) | HI |
G44098 | (02) | HI |