Provider Demographics
NPI:1578507448
Name:WONG, RAMONA L (MD)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:L
Last Name:WONG
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 1:1020 SPENCER ST
Mailing Address - Street 2:#5
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-5100
Mailing Address - Country:US
Mailing Address - Phone:808-521-4110
Mailing Address - Fax:808-521-4110
Practice Address - Street 1:1020 SPENCER ST
Practice Address - Street 2:#5
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-5100
Practice Address - Country:US
Practice Address - Phone:808-521-4110
Practice Address - Fax:808-521-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4443207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0011195OtherHMSA BLUE CROSS
HI01074601Medicaid
HI1578507448OtherNPI
H0000BDWVXMedicare ID - Type Unspecified
HI01074601Medicaid