Healthcare Provider Details

I. General information

NPI: 1437015112
Provider Name (Legal Business Name): MASON WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SAND ISLAND ACCESS RD
HONOLULU HI
96819-2200
US

IV. Provider business mailing address

91-1450 NOELO ST
EWA BEACH HI
96706-5929
US

V. Phone/Fax

Practice location:
  • Phone: 808-836-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: