Provider Demographics
NPI:1891200556
Name:WONG, MIKI (RDN)
Entity type:Individual
Prefix:
First Name:MIKI
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PUNAHOU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1027
Mailing Address - Country:US
Mailing Address - Phone:808-951-3607
Mailing Address - Fax:
Practice Address - Street 1:604 MAUNALOA HWY
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-560-3653
Practice Address - Fax:808-560-3385
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered