Provider Demographics
NPI:1457459653
Name:LEE LOY, HENRY K (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:K
Last Name:LEE LOY
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 1:670 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99-0239104OtherALL OTHER INSURANCES
HI99 0239104OtherHMA, INSURANCE
HI99 0239104OtherHMAA INSURANCE
HI0000016840OtherHMSA PROVIDER NUMBER
HI015674 01Medicaid
HI0000016840OtherHMSA PROVIDER NUMBER
HI99 0239104OtherHMA, INSURANCE