Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01062015A | IN |
Y | 2080P0201X | Pediatric Allergist | MD437462 | PA |
N | 2080P0214X | Pediatric Pulmonologist | MD437462 | PA |
NPI | 1790872646 |
---|---|
Provider Name | Dr. Bruce Ong |
First Address | Tripler Army Medical Center, HI 96859-5001 |
Second Address | Honolulu, HI 96759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 13/09/2021 |