Provider Demographics
NPI:1093745523
Name:WONG, BARON CKW (MD)
Entity type:Individual
Prefix:
First Name:BARON
Middle Name:CKW
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:94-1080 LUMIPOLU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3954
Mailing Address - Country:US
Mailing Address - Phone:808-781-6833
Mailing Address - Fax:412-506-8074
Practice Address - Street 1:94-1080 LUMIPOLU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3954
Practice Address - Country:US
Practice Address - Phone:808-781-6833
Practice Address - Fax:412-506-8074
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI11073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00J02269991OtherHMSA
HI00J02269991OtherHMSA
HIH35125Medicare UPIN