Provider Demographics
NPI:1457382772
Name:WONG, WILLIAM K SR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:WONG
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR. #703
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR.
Practice Address - Street 2:#703
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-487-7938
Practice Address - Fax:808-485-8022
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD03244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID36467Medicare UPIN