Healthcare Provider Details

I. General information

NPI: 1932393170
Provider Name (Legal Business Name): JANIE HEA-RYUNG YOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIE HEA-RYUNG LEE M.D.

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 KUKUI GROVE ST
LIHUE HI
96766-1674
US

IV. Provider business mailing address

4368 KUKUI GROVE ST
LIHUE HI
96766-1674
US

V. Phone/Fax

Practice location:
  • Phone: 808-378-9927
  • Fax: 808-515-5061
Mailing address:
  • Phone: 808-245-8765
  • Fax: 808-245-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number243630
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA103121
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM-2309
License Number StateGU
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18657
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: