Provider Demographics
NPI:1093071672
Name:WONG, WARREN (DAC)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MAUNAKEA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5132
Mailing Address - Country:US
Mailing Address - Phone:808-523-5499
Mailing Address - Fax:808-523-5499
Practice Address - Street 1:1125 MAUNAKEA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5132
Practice Address - Country:US
Practice Address - Phone:808-523-5499
Practice Address - Fax:808-523-5499
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist