Provider Demographics
NPI:1225711815
Name:WANG, GUOLONG (MAT)
Entity Type:Individual
Prefix:MR
First Name:GUOLONG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MAT
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:909 KAHEKA ST # B-405
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2450
Mailing Address - Country:US
Mailing Address - Phone:808-888-9683
Mailing Address - Fax:
Practice Address - Street 1:909 KAHEKA ST # B-405
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2450
Practice Address - Country:US
Practice Address - Phone:808-888-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-16103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty