Provider Demographics
NPI:1225196389
Name:ALOHA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:ALOHA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINONA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-941-3376
Mailing Address - Street 1:2525 S KING ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3154
Mailing Address - Country:US
Mailing Address - Phone:808-941-3376
Mailing Address - Fax:808-791-3366
Practice Address - Street 1:2525 S KING ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3154
Practice Address - Country:US
Practice Address - Phone:808-941-3376
Practice Address - Fax:808-791-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13301207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102198Medicare PIN