Provider Demographics
NPI:1154386415
Name:NG, GORDON WT (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:WT
Last Name:NG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-522-0190
Mailing Address - Fax:808-523-9068
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-522-0190
Practice Address - Fax:808-523-9068
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD77142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000095448OtherQUEST HMSA
HIB095444OtherHMSA
HI0095448OtherHMSA
HI07343502OtherQUEST ALOHACARE
HI00B0095444OtherQUEST HMSA
HI103802483OtherUS MARSHALL SVC-FED DET C
HI201243800OtherUS LABOR DEPT
HI300044845OtherPALMETTO GBA
HI073435-02OtherST DEPT OF PUB SAFETY
HI108-2145098OtherAETNA
HI990157698-96701-B005OtherTRICARE
HI0007343502Medicaid
HI0007343503Medicaid
HI990157698006OtherHI ELEC
HIMD7714OtherQUEENS HEALTHCARE
HI990157698-96817-E005OtherTRICARE
HI103802483OtherUS MARSHALL SVC-FED DET C
HI0007343503Medicaid