Provider Demographics
NPI:1164457511
Name:FOO, WENDELL K S (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:K S
Last Name:FOO
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 1:4348 WAIALAE AVE 5-311
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5767
Mailing Address - Country:US
Mailing Address - Phone:808-373-4007
Mailing Address - Fax:
Practice Address - Street 1:606 KILANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1904
Practice Address - Country:US
Practice Address - Phone:808-621-8448
Practice Address - Fax:808-621-2082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4923207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI025354-01Medicaid
HI191559/01OtherHMA/SUMMERLIN PROV. #
HIH0000BDNKQOtherMEDICARE ID
HI2821-7OtherHMSA PROV. # - HI
HI2821-7OtherBLUE CROSS/SHIELD PROV. #
HIH0000BDNKQOtherMEDICARE ID
HI025354-01Medicaid