Healthcare Provider Details

I. General information

NPI: 1346346384
Provider Name (Legal Business Name): SIMON K CHANG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE SUITE 701
HONOLULU HI
96814-1600
US

IV. Provider business mailing address

820 MILILANI ST STE 702A
HONOLULU HI
96813-2918
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-2854
  • Fax: 808-599-2891
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD 6692
License Number StateHI

VIII. Authorized Official

Name: SIMON K CHANG
Title or Position: MD
Credential: MD
Phone: 808-599-2854