Healthcare Provider Details

I. General information

NPI: 1407535289
Provider Name (Legal Business Name): KALEY HIO MAN WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 ALA WAI BLVD APT 403
HONOLULU HI
96815-3901
US

IV. Provider business mailing address

2609 ALA WAI BLVD APT 403
HONOLULU HI
96815-3901
US

V. Phone/Fax

Practice location:
  • Phone: 808-384-9736
  • Fax:
Mailing address:
  • Phone: 808-384-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: