Provider Demographics
NPI:1134206329
Name:WANG, VICTORIA A (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:A
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE #603
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-526-9702
Mailing Address - Fax:808-526-3121
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE #603
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-526-9702
Practice Address - Fax:808-526-3121
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI4954207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01602601Medicaid
HI01602601Medicaid
HI0000BDRXLMedicare ID - Type Unspecified