Healthcare Provider Details

I. General information

NPI: 1821516097
Provider Name (Legal Business Name): BRYSON CHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 WAIALAE AVE
HONOLULU HI
96816-5836
US

IV. Provider business mailing address

99-317A UWAU DR
AIEA HI
96701-3569
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-2719
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: