Healthcare Provider Details

I. General information

NPI: 1437234598
Provider Name (Legal Business Name): CHANG D LAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST 1015
HONOLULU HI
96813-2461
US

IV. Provider business mailing address

1380 LUSITANA ST 1015
HONOLULU HI
96813-2461
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-6761
  • Fax: 808-536-6740
Mailing address:
  • Phone: 808-537-6761
  • Fax: 808-536-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD6970
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: