=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316265366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KER-MING CHANG M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2010
-----------------------------------------------------
Last Update Date | 06/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 COOKE ST STE A PMB 2524
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-5274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-735-9093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 COOKE ST STE A PMB 2524
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-5274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-735-9093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | KER-MING CHANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-735-9093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD-4310
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------