Provider Demographics
NPI:1396798286
Name:DANG, MARY LAI UNG (PSY D)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LAI UNG
Last Name:DANG
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KALAKAUA AVE
Mailing Address - Street 2:708
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3766
Mailing Address - Country:US
Mailing Address - Phone:808-946-1882
Mailing Address - Fax:808-833-1708
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:606
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-486-6940
Practice Address - Fax:808-833-1708
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI497273-01Medicaid