Healthcare Provider Details

I. General information

NPI: 1144070459
Provider Name (Legal Business Name): REYNOLD WONG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 KAWAIAHAO ST
HONOLULU HI
96814
US

IV. Provider business mailing address

2666 LILIHA ST
HONOLULU HI
96817-7344
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-4677
  • Fax:
Mailing address:
  • Phone: 808-203-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. REYNOLD SUI LUN WONG
Title or Position: ACUPUNCTURIST
Credential: DACM
Phone: 808-203-4677