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General NPI Number Information
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NPI Number | 1447715651
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Entity Type | Organization
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Legal Business Name | JAIME PUA CHANG LLC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 1833 KALAKAUA AVE STE 908
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City | HONOLULU
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State | HI
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Zip | 96815-1528
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Country | US
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Telephone | 808-781-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 7423 MOKUHANO PL
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City | HONOLULU
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State | HI
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Zip | 96825-2831
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Country | US
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Telephone | 808-781-7632
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | JAIME CHANG
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Credential | PHD
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Telephone | 808-781-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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