Provider Demographics
NPI:1255405288
Name:WONG, LINDA L (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 LILIHA STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1605
Mailing Address - Country:US
Mailing Address - Phone:808-523-0166
Mailing Address - Fax:808-528-4940
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:SUIT 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1600
Practice Address - Country:US
Practice Address - Phone:808-523-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6194204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F08184OtherKAISER PERM
HI00740201Medicaid
MD6194OtherMDX
193563OtherHMA
00740201OtherALOHACARE
193563OtherHMA
MD6194OtherMDX