MEDICARE: DR. EUGENE G C WONG MD

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
1	207RN0300X	Nephrology Physician	1785	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CO34813	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1972598605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE G C WONG MD

Provider Business Mailing Address
First Line	:	1380 LUSITANA ST
Second Line	:	SUITE 814
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:	808-521-3802
Fax Number	:	808-521-1738

Provider Business Practice Location Address
First Line	:	1380 LUSITANA ST
Second Line	:	SUITE 814
City	:	HONOLULU
State	:	HI
Zip	:	96813-2449
Country	:	US
Telephone Number	:	808-521-3802
Fax Number	:	808-521-1738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/31/2014

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