Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DT 1701 | HI |
NPI | 1659379311 |
---|---|
Provider Name | Patrick John Kong Chang |
First Address | Honolulu, HI 96817-2115 |
Second Address | Honolulu, HI 96817-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070300-01 | (05) | HI |