Provider Demographics
NPI:1245394816
Name:WONG, LUCY M H F (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:M H F
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:M H
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94-1480 MOANIANI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4632
Mailing Address - Country:US
Mailing Address - Phone:808-432-3100
Mailing Address - Fax:
Practice Address - Street 1:94-1480 MOANIANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4632
Practice Address - Country:US
Practice Address - Phone:808-432-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI023836-01Medicaid
HI00B0026522OtherHMSA BILLING NUMBER
HIC23724Medicare UPIN