MEDICARE: CLIFFORD CHUN MING WONG MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD8895	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750455846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD CHUN MING WONG MD

Provider Business Mailing Address
First Line	:	347 NORTH KUAKINI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-2377
Country	:	US
Telephone Number	:	808-547-9139
Fax Number	:	808-547-9497

Provider Business Practice Location Address
First Line	:	347 NORTH KUAKINI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-2377
Country	:	US
Telephone Number	:	808-547-9139
Fax Number	:	808-547-9497

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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