Healthcare Provider Details

I. General information

NPI: 1174880173
Provider Name (Legal Business Name): CURTIS W LEE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MAUNA KEA ST
HILO HI
96720-3875
US

IV. Provider business mailing address

24 MAUNA KEA ST
HILO HI
96720-3875
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-6655
  • Fax: 808-935-5680
Mailing address:
  • Phone: 808-961-6655
  • Fax: 877-767-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number6209
License Number StateHI

VIII. Authorized Official

Name: DR. CURTIS LEE
Title or Position: PRES
Credential: M.D.
Phone: 808-961-6655