MEDICARE: INA B LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	15870	HI

General Provider Information

NPI Number	:	1669103370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INA B LEE

Provider Business Mailing Address
First Line	:	1188 BISHOP ST STE 1610
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-3306
Country	:	US
Telephone Number	:	808-699-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST STE 1610
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-3306
Country	:	US
Telephone Number	:	808-699-4449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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Directions to “ INA B LEE ” Practice Location

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