Individual
HENDERSON VICTOR WIJAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
(808) 433-3706
Mailing address
1 JARRETT WHITE RD, TRIPLER AMC, HI 96859-5001
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
—
—
363A00000X
Physician Assistant
Primary
1178843
—
363AM0700X
Medical Physician Assistant
Primary
028353
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1178843
NCCPA ID
—
Enumeration date
09/28/2015
Last updated
05/11/2026
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