Provider Demographics
NPI:1184773087
Name:LESLIE K L WONG DDS INC
Entity type:Organization
Organization Name:LESLIE K L WONG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K L
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-593-8222
Mailing Address - Street 1:1150 S KING STREET
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-593-8222
Mailing Address - Fax:
Practice Address - Street 1:1150 S KING STREET
Practice Address - Street 2:SUITE 309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-593-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty