Provider Demographics
NPI:1750455846
Name:WONG, CLIFFORD CHUN MING (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:CHUN MING
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 1:347 NORTH KUAKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2377
Mailing Address - Country:US
Mailing Address - Phone:808-547-9139
Mailing Address - Fax:808-547-9497
Practice Address - Street 1:347 NORTH KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2377
Practice Address - Country:US
Practice Address - Phone:808-547-9139
Practice Address - Fax:808-547-9497
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8895207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25260301Medicaid
53088Medicare ID - Type Unspecified
HI25260301Medicaid