Healthcare Provider Details

I. General information

NPI: 1649375718
Provider Name (Legal Business Name): STANLEY F.H. WONG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 KAPIOLANI BLVD STE 1021
HONOLULU HI
96814-3802
US

IV. Provider business mailing address

1600 KAPIOLANI BLVD STE 1021
HONOLULU HI
96814-3802
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-3522
  • Fax: 808-946-5114
Mailing address:
  • Phone: 808-955-3522
  • Fax: 808-946-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0918
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: