Provider Demographics
NPI:1043254113
Name:WANG, SYLVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 ULUNIU ST
Mailing Address - Street 2:MEDICAL CLINIC INC
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2517
Mailing Address - Country:US
Mailing Address - Phone:808-261-8345
Mailing Address - Fax:808-262-5239
Practice Address - Street 1:414 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2517
Practice Address - Country:US
Practice Address - Phone:808-261-8345
Practice Address - Fax:808-262-5239
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10946207R00000X
HIMD10946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52950Medicare PIN
HIH16389Medicare UPIN