Healthcare Provider Details

I. General information

NPI: 1801961909
Provider Name (Legal Business Name): EUGENE G C WONG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST STE 814
HONOLULU HI
96813-2444
US

IV. Provider business mailing address

1380 LUSITANA ST STE 814
HONOLULU HI
96813-2444
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1785
License Number StateHI

VIII. Authorized Official

Name: EUGENE G C WONG
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 808-521-3802