Provider Demographics
NPI:1174663330
Name:WONG, BRENDA JUNE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JUNE
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 S KUAKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1604
Mailing Address - Country:US
Mailing Address - Phone:808-535-7718
Mailing Address - Fax:808-535-7722
Practice Address - Street 1:55 MERCHANT ST
Practice Address - Street 2:22ND FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4306
Practice Address - Country:US
Practice Address - Phone:808-535-7700
Practice Address - Fax:808-535-7722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI353103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02407801Medicaid
HI02407802Medicaid
HI02678-5OtherQUEST PRV PRACTICE
HID20158-4OtherQUEST CLINIC