Provider Demographics
NPI:1912413295
Name:WONG, DAVIS J
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:J
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST FL 7
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-586-2890
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST FL 7
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-586-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2024-05-01
Deactivation Date:2024-04-13
Deactivation Code:
Reactivation Date:2024-05-01
Provider Licenses
StateLicense IDTaxonomies
HIMDR-8733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics