Provider Demographics
NPI:1063834281
Name:WONG, LISA WH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:WH
Last Name:WONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S BERETANIA ST
Mailing Address - Street 2:SUITE C-117B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2208
Mailing Address - Country:US
Mailing Address - Phone:808-538-6522
Mailing Address - Fax:
Practice Address - Street 1:50 S BERETANIA ST
Practice Address - Street 2:SUITE C-117B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2208
Practice Address - Country:US
Practice Address - Phone:808-538-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist