Provider Demographics
NPI:1477741726
Name:WONG, MANKWAN T (MD)
Entity Type:Individual
Prefix:
First Name:MANKWAN
Middle Name:T
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KALAKAUA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3700
Mailing Address - Country:US
Mailing Address - Phone:808-942-8727
Mailing Address - Fax:808-948-9649
Practice Address - Street 1:1750 KALAKAUA AVE STE 108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3700
Practice Address - Country:US
Practice Address - Phone:808-942-8727
Practice Address - Fax:808-948-9649
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11859332900000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB0235800OtherHMSA
HI50787402Medicaid
HIH107049Medicare UPIN
HIB0235800OtherHMSA
HI50787402Medicaid