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NPI Code Detail

MEDICARE: PATRICK JOHN KONG CHANG DDS

MEDICARE: PATRICK JOHN KONG CHANG DDS
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
11223D0001XPublic Health DentistryDT 1701HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659379311
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK JOHN KONG CHANG DDS
Provider Business Mailing Address
First Line : 1700 LANAKILA AVE
Second Line : 203
City : HONOLULU
State : HI
Zip : 96817-2115
Country : US
Telephone Number : 808-832-5710
Fax Number :
Provider Business Practice Location Address
First Line : 1700 LANAKILA AVE
Second Line : 203
City : HONOLULU
State : HI
Zip : 96817-2115
Country : US
Telephone Number : 808-832-5710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/09/2007

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Directions to “ PATRICK JOHN KONG CHANG DDS” Practice Location

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