Provider Demographics
NPI:1053444943
Name:ROBERT L K WONG DDS INC
Entity Type:Organization
Organization Name:ROBERT L K WONG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L K
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-735-2727
Mailing Address - Street 1:4211 WAIALAE AVENUE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-735-2727
Mailing Address - Fax:808-735-6060
Practice Address - Street 1:4211 WAIALAE AVENUE
Practice Address - Street 2:SUITE 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-735-2727
Practice Address - Fax:808-735-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI87361OtherHAWAII MEDICAL SERVICE AS
HI945OtherHAWAII DENTAL SERVICE