Healthcare Provider Details

I. General information

NPI: 1699818302
Provider Name (Legal Business Name): TAMMY M.L. CHANG-MOTOOKA D.D.S, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 520
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 520
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-3737
  • Fax: 808-947-3544
Mailing address:
  • Phone: 808-947-3737
  • Fax: 808-947-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1781
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: