Healthcare Provider Details

I. General information

NPI: 1053435842
Provider Name (Legal Business Name): MYRTLE YUEN CHAEN WONG PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRTLE WONG SCHLOSSER

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1238 KAAHUMANU ST #302
PEARL CITY HI
96782
US

IV. Provider business mailing address

88 PIIKOI #1203
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-3864
  • Fax:
Mailing address:
  • Phone: 808-381-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY882
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: