=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740402650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENE M.C. LEE, MD, APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 12/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 N KUAKINI ST STE 305
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-523-5688
-----------------------------------------------------
Fax | 808-523-0030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 N KUAKINI ST STE 305
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-523-5688
-----------------------------------------------------
Fax | 808-523-0030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. EUGENE MC LEE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-523-5688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD9489
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | MD9489
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD9489
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------