MEDICARE: BERTON NAOKI WONG D.D.S.

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	122300000X	Dentist	2667	HI

General Provider Information

NPI Number	:	1609322171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTON NAOKI WONG D.D.S.

Provider Business Mailing Address
First Line	:	1300 PALI HWY STE 211
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2206
Country	:	US
Telephone Number	:	808-538-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 PALI HWY STE 211
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2206
Country	:	US
Telephone Number	:	808-538-1076
Fax Number	:

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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