Provider Demographics
NPI:1629076427
Name:LEE, KENNETH KH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KH
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-585-7995
Mailing Address - Fax:808-585-7990
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 1004
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-585-7995
Practice Address - Fax:808-585-7990
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI146911XXOtherPREFERRED CARE
HI99-0189219OtherTRICARE WEST
HI00C004184-2OtherHMSA-QUEST
HI038114-01Medicaid
HIC4184-2OtherHMSA
HI00C004184-2OtherHMSA-QUEST