Provider Demographics
NPI:1801961909
Name:EUGENE G C WONG MD INC
Entity type:Organization
Organization Name:EUGENE G C WONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:G C
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-521-3802
Mailing Address - Street 1:1380 LUSITANA ST STE 814
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2444
Mailing Address - Country:US
Mailing Address - Phone:808-521-3802
Mailing Address - Fax:
Practice Address - Street 1:1380 LUSITANA ST STE 814
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2444
Practice Address - Country:US
Practice Address - Phone:808-521-3802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03139301Medicaid
HICO34813OtherHMSA
HIH54217Medicare ID - Type Unspecified