Healthcare Provider Details

I. General information

NPI: 1063632438
Provider Name (Legal Business Name): HAWAII DERMATOLOGY & SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR #703
AIEA HI
96701-3925
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR #703
AIEA HI
96701-3925
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7938
  • Fax: 808-485-8022
Mailing address:
  • Phone: 808-487-7938
  • Fax: 808-485-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD 03244
License Number StateHI

VIII. Authorized Official

Name: WILLIAM K WONG SR.
Title or Position: DERMATOLOGIST
Credential: M.D.
Phone: 808-487-7938