Provider Demographics
NPI:1376698886
Name:JOHN C.H. LEE M.D. INC.
Entity Type:Organization
Organization Name:JOHN C.H. LEE M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CH
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-841-3644
Mailing Address - Street 1:2153 N KING ST
Mailing Address - Street 2:STE 321
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4570
Mailing Address - Country:US
Mailing Address - Phone:808-841-3644
Mailing Address - Fax:808-841-3555
Practice Address - Street 1:2153 N KING ST
Practice Address - Street 2:STE 321
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4570
Practice Address - Country:US
Practice Address - Phone:808-841-3644
Practice Address - Fax:808-841-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI440F-01261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05766101Medicaid
HI0000BDVRWMedicare ID - Type Unspecified