Healthcare Provider Details

I. General information

NPI: 1114194750
Provider Name (Legal Business Name): LEE NAKAMURA GOERNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-800 UKEE ST #300
WAIPAHU HI
96797-4044
US

IV. Provider business mailing address

3515 NIPO ST
HONOLULU HI
96822-1142
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-1500
  • Fax:
Mailing address:
  • Phone: 504-292-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18330
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP1372
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101254985
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: