=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972660736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRWIN K. M. LEE M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1024 PIIKOI ST SUITE 3
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-596-0091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 PIIKOI ST SUITE 3
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-596-0091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IRWIN KWAI MUN LEE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-596-0091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2955
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------