Healthcare Provider Details

I. General information

NPI: 1891988408
Provider Name (Legal Business Name): JASON CHOKICHI CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N KUAKINI STREET
HONOLULU HI
96817
US

IV. Provider business mailing address

2230 LILIHA ST STE 104
HONOLULU HI
96817-1646
US

V. Phone/Fax

Practice location:
  • Phone: 808-544-3325
  • Fax: 808-535-2001
Mailing address:
  • Phone: 808-261-4476
  • Fax: 808-263-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number14616
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: