Provider Demographics
NPI:1255540779
Name:WONG, ROBERT LK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LK
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WAIALAE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5316
Mailing Address - Country:US
Mailing Address - Phone:808-735-2727
Mailing Address - Fax:808-735-6060
Practice Address - Street 1:4211 WAIALAE AVE STE 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5316
Practice Address - Country:US
Practice Address - Phone:808-735-2727
Practice Address - Fax:808-735-6060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice