Provider Demographics
NPI:1568439974
Name:WONG, WINONA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WINONA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S KING ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3154
Mailing Address - Country:US
Mailing Address - Phone:808-791-3367
Mailing Address - Fax:808-791-3366
Practice Address - Street 1:2525 S KING ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3154
Practice Address - Country:US
Practice Address - Phone:808-791-3364
Practice Address - Fax:808-791-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13301207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG67184Medicare UPIN
HIH102199Medicare PIN