Organization
WALLACE F. CHONG, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE F. CHONG III DDS (PRESIDENT)
(808) 935-5651
Entity
Organization
Contact information
Practice address
74 PONAHAWAI ST, HILO, HI 96720-3026
(808) 935-5651
(808) 935-5551
Mailing address
74 PONAHAWAI ST, HILO, HI 96720-3026
(808) 935-5651
(808) 935-5551
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504226 01
—
HI
Enumeration date
03/06/2007
Last updated
08/22/2020
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