MEDICARE: DERMATOLOGY SPECIALISTS OF HAWAII, LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1891506739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY SPECIALISTS OF HAWAII, LLC

Provider Business Mailing Address
First Line	:	918 KAHENA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1077
Country	:	US
Telephone Number	:	808-341-2541
Fax Number	:

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	:	PRACTICE OWNER
Name	:	DR. EMILY WONG
Credential	:	MD
Telephone Number	:	808-341-2541

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	02/04/2025

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