Provider Demographics
NPI:1407017973
Name:WONG, VICTORIA SAN SAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:SAN SAN
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S BERETANIA ST STE 405
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2496
Mailing Address - Country:US
Mailing Address - Phone:808-691-8866
Mailing Address - Fax:808-691-8865
Practice Address - Street 1:550 S BERETANIA ST STE 405
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2496
Practice Address - Country:US
Practice Address - Phone:808-691-8866
Practice Address - Fax:808-691-8865
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1573152084N0400X
MI43010983672084N0400X
CAA1068122084N0400X
HIMD-187122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology