Provider Demographics
NPI:1457369571
Name:WONG, SONNY JH (MD)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:JH
Last Name:WONG
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 1:25 MALUNIU AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5807
Mailing Address - Country:US
Mailing Address - Phone:808-261-2441
Mailing Address - Fax:808-261-2447
Practice Address - Street 1:25 MALUNIU AVE STE 201
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5807
Practice Address - Country:US
Practice Address - Phone:808-261-2441
Practice Address - Fax:808-261-2447
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5032207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05107202Medicaid
HI54047Medicare ID - Type Unspecified
HIA29653Medicare UPIN