Healthcare Provider Details

I. General information

NPI: 1295811636
Provider Name (Legal Business Name): MANKWAN WONG, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 KALAKAUA AVE STE 108
HONOLULU HI
96826-3700
US

IV. Provider business mailing address

1750 KALAKAUA AVE STE 108
HONOLULU HI
96826-3700
US

V. Phone/Fax

Practice location:
  • Phone: 808-942-8727
  • Fax: 808-946-9849
Mailing address:
  • Phone: 808-942-8727
  • Fax: 808-946-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11859
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number11859
License Number StateHI

VIII. Authorized Official

Name: DR. MANKWAN THOMAS WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-942-8727