MEDICARE: DR. EMILY BETH WONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	R8511	TX
2	207ND0101X	MOHS-Micrographic Surgery Physician	MD-13951	HI
3	207N00000X	Dermatology Physician	MD-13951	HI

General Provider Information

NPI Number	:	1518057009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY BETH WONG M.D.

Provider Business Mailing Address
First Line	:	99-128 AIEA HEIGHTS DR STE 701
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3940
Country	:	US
Telephone Number	:	808-888-3311
Fax Number	:	808-888-3315

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DR STE 701
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3940
Country	:	US
Telephone Number	:	808-888-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/19/2025

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