Provider Demographics
NPI:1093745523
Name:WONG, BARON CKW (MD)
Entity Type:Individual
Prefix:
First Name:BARON
Middle Name:CKW
Last Name:WONG
Suffix:
Gender:M
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:PO BOX 37747
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0747
Mailing Address - Country:US
Mailing Address - Phone:808-358-5069
Mailing Address - Fax:808-536-9179
Practice Address - Street 1:128 LEHUA ST FL 1
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2036
Practice Address - Country:US
Practice Address - Phone:808-621-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00J02269991OtherHMSA
HI00J02269991OtherHMSA
HIH35125Medicare UPIN