Healthcare Provider Details

I. General information

NPI: 1780426718
Provider Name (Legal Business Name): MICHAEL WANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FARRINGTON HWY UNIT 155
KAPOLEI HI
96707-2011
US

IV. Provider business mailing address

91-1272 ULUAHEWA ST
EWA BEACH HI
96706-5849
US

V. Phone/Fax

Practice location:
  • Phone: 808-427-9987
  • Fax:
Mailing address:
  • Phone: 480-299-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3290
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: