Provider Demographics
NPI:1235226572
Name:WONG, DARYL M (DDS)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:M
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DARYL
Other - Middle Name:M C
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4211 WAIALAE AVENUE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5318
Mailing Address - Country:US
Mailing Address - Phone:808-732-0933
Mailing Address - Fax:808-737-2605
Practice Address - Street 1:4211 WAIALAE AVENUE
Practice Address - Street 2:SUITE 505
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5318
Practice Address - Country:US
Practice Address - Phone:808-732-0933
Practice Address - Fax:808-737-2605
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1271OtherHAWAII STATE DEPT OF COMM
HI14902OtherHAWAII MEDICAL SERVICES A