Provider Demographics
NPI:1356475933
Name:HENRY K LEE LOY MD INC
Entity Type:Organization
Organization Name:HENRY K LEE LOY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNEST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE LOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-969-2011
Mailing Address - Street 1:670 PONAHAWAI ST STE 218
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-969-2011
Mailing Address - Fax:808-969-3480
Practice Address - Street 1:670 PONAHAWAI ST STE 218
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-969-2011
Practice Address - Fax:808-969-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01567401Medicaid
HI$$$$$$$$$OtherSOCIAL SECURITY NUMBER
HI0016840OtherHMSA INSURANCE
HI01567401Medicaid
HID36171Medicare UPIN