Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | A104571 | CA |
Y | 208000000X | Pediatrician | 4804 | HI |
NPI | 1316130321 |
---|---|
Provider Name | Jeffrey A Wong |
First Address | Honolulu, HI 96813-4920 |
Second Address | Honolulu, HI 96813-4920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 01/05/2010 |