Healthcare Provider Details

I. General information

NPI: 1306230602
Provider Name (Legal Business Name): SUZANNA LEE LEWIS GRIMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE STE J-1
MILILANI HI
96789-1192
US

IV. Provider business mailing address

95-390 KUAHELANI AVE STE J-1
MILILANI HI
96789-1192
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6444
  • Fax:
Mailing address:
  • Phone: 808-909-3252
  • Fax: 808-909-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number022173
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20232
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: