Provider Demographics
NPI:1063632438
Name:HAWAII DERMATOLOGY & SURGERY, INC
Entity type:Organization
Organization Name:HAWAII DERMATOLOGY & SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:WONG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-487-7938
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:#703
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3925
Mailing Address - Country:US
Mailing Address - Phone:808-487-7938
Mailing Address - Fax:808-485-8022
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 03244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty