Provider Demographics
NPI:1356477640
Name:WONG, THEODORE FO KONG (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:FO KONG
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD STE 1021
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3802
Mailing Address - Country:US
Mailing Address - Phone:808-955-3522
Mailing Address - Fax:808-946-5114
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 1021
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3802
Practice Address - Country:US
Practice Address - Phone:808-955-3522
Practice Address - Fax:808-946-5114
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics