Provider Demographics
NPI:1295811636
Name:MANKWAN WONG, M.D., LLC
Entity type:Organization
Organization Name:MANKWAN WONG, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANKWAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-942-8727
Mailing Address - Street 1:1750 KALAKAUA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3700
Mailing Address - Country:US
Mailing Address - Phone:808-942-8727
Mailing Address - Fax:808-946-9849
Practice Address - Street 1:1750 KALAKAUA AVE STE 108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3700
Practice Address - Country:US
Practice Address - Phone:808-942-8727
Practice Address - Fax:808-946-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11859332900000X
HIMD11859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50787402Medicaid
H30973Medicare UPIN
HIH106690Medicare UPIN
HI50787402Medicaid