MEDICARE: KENNETH KWAN-HYUN CHANG M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD17620	HI

General Provider Information

NPI Number	:	1134236821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH KWAN-HYUN CHANG M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1839 LAUKAHI STREET
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1273
Country	:	US
Telephone Number	:	808-373-9373
Fax Number	:	808-373-9370

Provider Business Practice Location Address
First Line	:	6600 KALANIANAOLE HWY STE 114C
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1273
Country	:	US
Telephone Number	:	808-373-9373
Fax Number	:	808-373-9370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/21/2022

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