Provider Demographics
NPI:1215667316
Name:WONG, JILL R (RRT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:WONG
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:NAKAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:1766 ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2643
Mailing Address - Country:US
Mailing Address - Phone:808-462-8504
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRT-99227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered