Healthcare Provider Details

I. General information

NPI: 1891760260
Provider Name (Legal Business Name): LISA L WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date: 02/21/2006
Reactivation Date: 09/25/2007

III. Provider practice location address

1380 LUSITANA ST SUITE 506
HONOLULU HI
96813
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 506
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-6922
  • Fax: 808-524-6923
Mailing address:
  • Phone: 808-524-6922
  • Fax: 808-524-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD11352
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: