Healthcare Provider Details

I. General information

NPI: 1871871285
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST STE 309
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

848 S BERETANIA ST STE 309
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-1951
  • Fax: 808-537-1952
Mailing address:
  • Phone: 808-537-1951
  • Fax: 808-537-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberW4079987801
License Number StateHI

VIII. Authorized Official

Name: DR. RUSSELL WONG
Title or Position: PRESIDENT
Credential:
Phone: 808-537-1951