Healthcare Provider Details

I. General information

NPI: 1740402650
Provider Name (Legal Business Name): EUGENE M.C. LEE, MD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 305
HONOLULU HI
96817-2360
US

IV. Provider business mailing address

321 N KUAKINI ST STE 305
HONOLULU HI
96817-2360
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-5688
  • Fax: 808-523-0030
Mailing address:
  • Phone: 808-523-5688
  • Fax: 808-523-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD9489
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD9489
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD9489
License Number StateHI

VIII. Authorized Official

Name: DR. EUGENE MC LEE
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 808-523-5688