1013911924 NPI number — DR. ALLAN VEH TUC WANG MD, PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013911924 NPI number — DR. ALLAN VEH TUC WANG MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
ALLAN
Provider Middle Name:
VEH TUC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANG
Provider Other First Name:
ALLAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013911924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-166 KALANI ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-1857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-329-9264
Provider Business Mailing Address Fax Number:
808-329-9260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75-166 KALANI ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-1857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-329-9264
Provider Business Practice Location Address Fax Number:
808-329-9260
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  9287 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07646003 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0204000 . This is a "HAWAII BCBS PROVIDER ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: C0204002 . This is a "HMSA / BCBS HILO OFFICE #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E0204007 . This is a "HMSA / BCBS HNL OFFICE #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: F0204005 . This is a "HMSA / BCBS KAMUELA #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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