Provider Demographics
NPI:1831287820
Name:WONG, CARLSON B (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLSON
Middle Name:B
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2226 LILIHA ST
Mailing Address - Street 2:#303
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-538-1449
Mailing Address - Fax:808-538-3843
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:#303
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-538-1449
Practice Address - Fax:808-538-3843
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD7355207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02152601Medicaid
HI02152601Medicaid
F48229Medicare UPIN