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General NPI Number Information
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NPI Number | 1235354887
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Entity Type | Organization
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Legal Business Name | BERT KW WONG MD LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 2228 LILIHA ST SUITE 305
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City | HONOLULU
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State | HI
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Zip | 96817-1646
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Country | US
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Telephone | 808-526-0686
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Fax | 808-526-0688
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Provider Business Mailing Address
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Address Line | 2228 LILIHA ST SUITE 305
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City | HONOLULU
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State | HI
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Zip | 96817-1646
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Country | US
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Telephone | 808-526-0686
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Fax | 808-526-0688
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Authorized Official
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Title or Position | OWNER
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Name | BERT KW WONG
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Credential | MD
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Telephone | 808-526-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 3694
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License Number State | HI
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