Healthcare Provider Details

I. General information

NPI: 1265816029
Provider Name (Legal Business Name): LAURA JUJIN CHANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE STE 111
HONOLULU HI
96816-5300
US

IV. Provider business mailing address

5324 KALANIANAOLE HWY
HONOLULU HI
96821-1934
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-4377
  • Fax:
Mailing address:
  • Phone: 206-291-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2606
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: