Healthcare Provider Details

I. General information

NPI: 1326974148
Provider Name (Legal Business Name): TAE KWAN LEE MCHS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 102
HONOLULU HI
96814-1871
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 102
HONOLULU HI
96814-1871
US

V. Phone/Fax

Practice location:
  • Phone: 808-356-5699
  • Fax:
Mailing address:
  • Phone: 808-356-5699
  • Fax: 808-356-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1584
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: