Provider Demographics
NPI:1629056528
Name:LEE, JEFFREY J K (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J K
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 1:1380 LUSITANA ST., SUITE 407
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2439
Mailing Address - Country:US
Mailing Address - Phone:808-523-8833
Mailing Address - Fax:808-528-1751
Practice Address - Street 1:1380 LUSITANA ST., SUITE 407
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2439
Practice Address - Country:US
Practice Address - Phone:808-523-8833
Practice Address - Fax:808-528-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05957501Medicaid
HIE69733Medicare UPIN
HI1629056528Medicare NSC