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General NPI Number Information
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NPI Number | 1821688508
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Entity Type | Organization
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Legal Business Name | ISLAND MEDICAL AND BEAUTY CLINIC LLC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 10/29/2022
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Provider Practice Location Address
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Address Line | 3470 WAIALAE AVE STE 6
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City | HONOLULU
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State | HI
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Zip | 96816-2654
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Country | US
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Telephone | 808-888-3100
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Fax | 833-673-0575
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Provider Business Mailing Address
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Address Line | 3470 WAIALAE AVE STE 6
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City | HONOLULU
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State | HI
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Zip | 96816-2654
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Country | US
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Telephone | 808-888-3100
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Fax | 833-673-0575
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LE LEE
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Credential | DO
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Telephone | 808-466-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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