Healthcare Provider Details

I. General information

NPI: 1508893967
Provider Name (Legal Business Name): SHAY J LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2141 FORT WEAVER RD
EWA BEACH HI
96706-1993
US

IV. Provider business mailing address

PO BOX 971135
WAIPAHU HI
96797-8135
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3000
  • Fax:
Mailing address:
  • Phone: 808-447-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD-7517
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: