Healthcare Provider Details

I. General information

NPI: 1255769303
Provider Name (Legal Business Name): CHANG DICH LAI M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 1015
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 1015
HONOLULU HI
96813-2449
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberMD6970
License Number StateHI

VIII. Authorized Official

Name: DR. CHANG DICH LAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-537-6761