1972662385 NPI number — DR. BERT K W WONG MD

Table of content: (NPI 1134129299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972662385 NPI number — DR. BERT K W WONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
BERT
Provider Middle Name:
K W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1972662385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2228 LILIHA ST.
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-526-0686
Provider Business Mailing Address Fax Number:
808-526-0688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2228 LILIHA ST.
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-526-0686
Provider Business Practice Location Address Fax Number:
808-526-0688
Provider Enumeration Date:
12/08/2006

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: 207RC0000X , with the licence number:  3694 , 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: 01598201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C17149 . This is a "HMSA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com