Provider Demographics
NPI:1518539774
Name:CHANG, MARY JOOEUN (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOOEUN
Last Name:CHANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FARRINGTON HWY UNIT 155
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2011
Mailing Address - Country:US
Mailing Address - Phone:808-427-9987
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY UNIT 155
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2011
Practice Address - Country:US
Practice Address - Phone:808-427-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-31451223G0001X
CA1082751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice