=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952207243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN LEE ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2026
-----------------------------------------------------
Last Update Date | 10/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 771 AMANA ST # 201
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-371-3359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 949 18TH AVE
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-4114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-371-3359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT-176
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------