Healthcare Provider Details

I. General information

NPI: 1891015707
Provider Name (Legal Business Name): CHRISTINE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-7657
  • Fax:
Mailing address:
  • Phone: 808-691-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02005
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number254225
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18216
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: