Provider Demographics
NPI:1043396096
Name:WEN, AIDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:B
Last Name:WEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AIDA
Other - Middle Name:B
Other - Last Name:WON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:677 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5419
Mailing Address - Country:US
Mailing Address - Phone:808-523-8461
Mailing Address - Fax:808-535-5976
Practice Address - Street 1:347 N. KUAKINI STREET
Practice Address - Street 2:HPM-9
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:808-528-1897
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585979-01Medicaid
HIG26334Medicare UPIN