Provider Demographics
NPI:1750867727
Name:MA, JOANNA NGOC (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:NGOC
Last Name:MA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:935 PUEO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5234
Mailing Address - Country:US
Mailing Address - Phone:808-398-5785
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5300
Practice Address - Country:US
Practice Address - Phone:808-737-5811
Practice Address - Fax:808-737-7971
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist