Provider Demographics
NPI:1194887463
Name:WHANG, EDMUND SM (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:SM
Last Name:WHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAKANI AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1914
Mailing Address - Country:US
Mailing Address - Phone:808-622-4191
Mailing Address - Fax:808-621-5742
Practice Address - Street 1:34 MAKANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1914
Practice Address - Country:US
Practice Address - Phone:808-622-4191
Practice Address - Fax:808-621-5742
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03530901Medicaid
HI003899-2OtherHMSA
HI03530901Medicaid
HI003899-2OtherHMSA