Healthcare Provider Details

I. General information

NPI: 1316178924
Provider Name (Legal Business Name): EUGENE G. C. WONG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD SUITE 7-301
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

500 ALA MOANA BLVD SUITE 7-301
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-3802
  • Fax: 808-521-1738
Mailing address:
  • Phone: 808-521-3802
  • Fax: 808-521-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDOS1270
License Number StateHI

VIII. Authorized Official

Name: MR. EUGUENE WONG
Title or Position: OWNER/OPERATOR
Credential: MD
Phone: 808-521-3802