Healthcare Provider Details

I. General information

NPI: 1801291562
Provider Name (Legal Business Name): LEE HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LILIHA ST
HONOLULU HI
96817-1600
US

IV. Provider business mailing address

2226 LILIHA ST
HONOLULU HI
96817-1600
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-6883
  • Fax:
Mailing address:
  • Phone: 808-547-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12913 - 24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1212447
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3883
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: