Healthcare Provider Details

I. General information

NPI: 1588649909
Provider Name (Legal Business Name): MATTHEW WILLIAM CHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAKALAPA DR COMPACFLT HEALTH SERVICES (N01HD), ATTN: PROF AFF COORD
PEARL HARBOR HI
96860-3131
US

IV. Provider business mailing address

250 MAKALAPA DR COMPACFLT HEALTH SERVICES (N01HD), ATTN PROF AFF COORD
PEARL HARBOR HI
96860-3131
US

V. Phone/Fax

Practice location:
  • Phone: 619-572-3850
  • Fax:
Mailing address:
  • Phone: 619-321-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number051611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: