Provider Demographics
NPI:1316062268
Name:WONG-GARY, KATHRYN MEI LIN (LMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MEI LIN
Last Name:WONG-GARY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MEI LIN
Other - Middle Name:
Other - Last Name:WONG-GARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1746
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-1746
Mailing Address - Country:US
Mailing Address - Phone:808-966-6076
Mailing Address - Fax:808-966-6076
Practice Address - Street 1:17384 MOMONA RD
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760-1746
Practice Address - Country:US
Practice Address - Phone:808-966-6076
Practice Address - Fax:808-966-6076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 3085171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor