Provider Demographics
NPI:1730277377
Name:WONG, RANDOLPH KAI MING (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:KAI MING
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 235627
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3510
Mailing Address - Country:US
Mailing Address - Phone:808-792-6262
Mailing Address - Fax:808-792-6263
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:STE 808
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-792-6262
Practice Address - Fax:808-792-6263
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-73022086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC32117Medicare UPIN