Healthcare Provider Details

I. General information

NPI: 1730277377
Provider Name (Legal Business Name): RANDOLPH KAI MING WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE STE 808
HONOLULU HI
96814-1600
US

IV. Provider business mailing address

PO BOX 235627
HONOLULU HI
96823-3510
US

V. Phone/Fax

Practice location:
  • Phone: 808-792-6262
  • Fax: 808-792-6263
Mailing address:
  • Phone: 808-792-6262
  • Fax: 808-792-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD-7302
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: