Provider Demographics
NPI:1376800847
Name:WONG, ISAAC KEKOA
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:KEKOA
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-163 KALEIWOHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3682
Mailing Address - Country:US
Mailing Address - Phone:808-391-9272
Mailing Address - Fax:
Practice Address - Street 1:87-163 KALEIWOHI ST
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3682
Practice Address - Country:US
Practice Address - Phone:808-391-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60229119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist