Provider Demographics
NPI:1144416835
Name:ROBERT WONG, MD, L.L.C.
Entity Type:Organization
Organization Name:ROBERT WONG, MD, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-486-0449
Mailing Address - Street 1:98-211 PALI MOMI STREET
Mailing Address - Street 2:SUITE 312
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4714
Mailing Address - Country:US
Mailing Address - Phone:808-486-0449
Mailing Address - Fax:808-488-0725
Practice Address - Street 1:98-211 PALI MOMI STREET
Practice Address - Street 2:SUITE 312
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4714
Practice Address - Country:US
Practice Address - Phone:808-486-0449
Practice Address - Fax:808-488-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X
HIMD11244261QE0800X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital