Provider Demographics
NPI:1972662385
Name:WONG, BERT K W (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:K W
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 1:2228 LILIHA ST.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1646
Mailing Address - Country:US
Mailing Address - Phone:808-526-0686
Mailing Address - Fax:808-526-0688
Practice Address - Street 1:2228 LILIHA ST.
Practice Address - Street 2:SUITE 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-526-0686
Practice Address - Fax:808-526-0688
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01598201Medicaid
C17149OtherHMSA
C17149OtherHMSA
HI101008Medicare ID - Type Unspecified