Provider Demographics
NPI:1689932089
Name:WANG, CHARLIE KIAT MENG
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:KIAT MENG
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:KIAK
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1356 LUSITANA ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2409
Mailing Address - Country:US
Mailing Address - Phone:808-586-2890
Mailing Address - Fax:
Practice Address - Street 1:1356 LUSITANA ST
Practice Address - Street 2:SUITE 510
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2409
Practice Address - Country:US
Practice Address - Phone:808-586-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR 6684390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program