Provider Demographics
NPI:1013911924
Name:WANG, ALLAN VEH TUC (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:VEH TUC
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:75-166 KALANI ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1857
Mailing Address - Country:US
Mailing Address - Phone:808-329-9264
Mailing Address - Fax:808-329-9260
Practice Address - Street 1:75-166 KALANI ST
Practice Address - Street 2:SUITE 204
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1857
Practice Address - Country:US
Practice Address - Phone:808-329-9264
Practice Address - Fax:808-329-9260
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9287207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07646003Medicaid
HID0204000OtherHAWAII BCBS PROVIDER ID
HIC0204002OtherHMSA / BCBS HILO OFFICE #
HIE0204007OtherHMSA / BCBS HNL OFFICE #
HIF0204005OtherHMSA / BCBS KAMUELA #
HIC0204002OtherHMSA / BCBS HILO OFFICE #
HI07646003Medicaid