Healthcare Provider Details

I. General information

NPI: 1144416835
Provider Name (Legal Business Name): ROBERT WONG, MD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-211 PALI MOMI STREET SUITE 312
AIEA HI
96701-4714
US

IV. Provider business mailing address

98-211 PALI MOMI STREET SUITE 312
AIEA HI
96701-4714
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-0449
  • Fax: 808-488-0725
Mailing address:
  • Phone: 808-486-0449
  • Fax: 808-488-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberMD11244
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberMD11244
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT FRANCISCO WONG
Title or Position: OWNER
Credential: MD
Phone: 808-486-0449