Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 051611 | NY |
NPI | 1588649909 |
---|---|
Provider Name | Dr. Matthew William Chang |
First Address | Pearl Harbor, HI 96860-3131 |
Second Address | Pearl Harbor, HI 96860-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 08/07/2007 |