=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932390515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADFORD K.K. LEE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 08/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 KAPIOLANI BLVD SUITE #306
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-596-8090
-----------------------------------------------------
Fax | 808-596-2312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 KAPIOLANI BLVD SUITE #306
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-596-8090
-----------------------------------------------------
Fax | 808-596-2312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0900X
-----------------------------------------------------
Taxonomy Name | Internist Chiropractor
-----------------------------------------------------
License Number | DC517
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------