Healthcare Provider Details

I. General information

NPI: 1225196389
Provider Name (Legal Business Name): ALOHA DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S KING ST SUITE 304
HONOLULU HI
96826-3154
US

IV. Provider business mailing address

2525 S KING ST SUITE 304
HONOLULU HI
96826-3154
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-3376
  • Fax: 808-791-3366
Mailing address:
  • Phone: 808-941-3376
  • Fax: 808-791-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD13301
License Number StateHI

VIII. Authorized Official

Name: DR. WINONA Y WONG
Title or Position: OWNER
Credential: M.D.
Phone: 808-941-3376