=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376698886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN C H LEE M D INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2153 N KING ST STE 321
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-4570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-841-3644
-----------------------------------------------------
Fax | 808-841-3555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2153 N KING ST STE 321
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-841-3644
-----------------------------------------------------
Fax | 213-915-3080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN CH LEE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-841-3644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 440F-01
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------