Basic Information
| Provider Information | |||||||||
| NPI: | 1689932089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | CHARLIE | ||||||||
| MiddleName: | KIAT MENG | ||||||||
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| OtherLastName: | WANG | ||||||||
| OtherFirstName: | CHARLIE | ||||||||
| OtherMiddleName: | KIAK | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1356 LUSITANA ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085862890 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1356 LUSITANA ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085862890 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MDR 6684 | HI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.