Provider Demographics
NPI:1427635051
Name:CHANG, KEVIN KIN TUCK (ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:KIN TUCK
Last Name:CHANG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1410 MOANIANI ST STE C
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6207
Mailing Address - Country:US
Mailing Address - Phone:808-678-8467
Mailing Address - Fax:
Practice Address - Street 1:94-1410 MOANIANI ST STE C
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6207
Practice Address - Country:US
Practice Address - Phone:808-678-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer