Provider Demographics
NPI:1114194750
Name:GOERNER, LEE NAKAMURA (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:NAKAMURA
Last Name:GOERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 NIPO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1142
Mailing Address - Country:US
Mailing Address - Phone:504-292-6804
Mailing Address - Fax:
Practice Address - Street 1:94-800 UKEE ST
Practice Address - Street 2:#300
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4044
Practice Address - Country:US
Practice Address - Phone:808-676-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI183302085R0202X
390200000X
TXP13722085R0202X
VA01012549852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program