Provider Demographics
NPI:1497841365
Name:WING, ADRIENNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:WING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:#507
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-522-0644
Mailing Address - Fax:808-522-0645
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:#507
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-522-0644
Practice Address - Fax:808-522-0645
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C04143Medicare UPIN
HIBDMWTMedicare ID - Type Unspecified