Provider Demographics
NPI:1295814614
Name:LEE, UNG (MD)
Entity Type:Individual
Prefix:
First Name:UNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 AINAKAHELE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3553
Mailing Address - Country:US
Mailing Address - Phone:808-959-3695
Mailing Address - Fax:808-959-4986
Practice Address - Street 1:2300 AINAKAHELE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3553
Practice Address - Country:US
Practice Address - Phone:808-959-3695
Practice Address - Fax:808-959-4986
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2743207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0003924-8OtherHMSA
HI03556200OtherALOHA CARE
HI197022-11OtherHMA,INC.DBA
HI39248OtherHMSA QUEST
HI035562Medicaid
HI03556200OtherALOHA CARE
HOOOOBDDHKMedicare ID - Type Unspecified