Provider Demographics
NPI:1376621334
Name:WONG, DEEN L (MD)
Entity Type:Individual
Prefix:
First Name:DEEN
Middle Name:L
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0652
Mailing Address - Country:US
Mailing Address - Phone:808-322-9366
Mailing Address - Fax:808-324-1892
Practice Address - Street 1:79-1019 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7920
Practice Address - Country:US
Practice Address - Phone:808-322-9366
Practice Address - Fax:808-324-1892
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4676207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD4676OtherQUEENS
HI1407901Medicaid
HI990280549OtherHMAA
HIA14983OtherHMSA
HIMD4676OtherQUEENS
HI52921Medicare ID - Type Unspecified