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General NPI Number Information
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NPI Number | 1871871285
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Entity Type | Organization
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Legal Business Name | MEDICAL SPECIALISTS OF HAWAII, LLC
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 848 S BERETANIA ST STE 309
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City | HONOLULU
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State | HI
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Zip | 96813-2551
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Country | US
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Telephone | 808-537-1951
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Fax | 808-537-1952
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Provider Business Mailing Address
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Address Line | 848 S BERETANIA ST STE 309
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City | HONOLULU
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State | HI
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Zip | 96813-2551
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Country | US
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Telephone | 808-537-1951
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Fax | 808-537-1952
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL WONG
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Credential |
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Telephone | 808-537-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | W4079987801
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License Number State | HI
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