1134215551 NPI number — DR. JOCELYN U CHANG DO

Table of content: DR. JOCELYN U CHANG DO (NPI 1134215551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134215551 NPI number — DR. JOCELYN U CHANG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
JOCELYN
Provider Middle Name:
U
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134215551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45-549 PLUMERIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOKAA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96727-6902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-775-7204
Provider Business Mailing Address Fax Number:
808-775-7204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53-3925 AKONI PULE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAAU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-889-6236
Provider Business Practice Location Address Fax Number:
808-889-0107
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  DOS769 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 079683-04 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: DOS-769 . This is a "STATE LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E02636 . This is a "CONTROLLED SUBSTANCES" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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